高龄老年女性盆底重建手术治疗方式(附21例临床分析)

Surgical treatment of pelvic floor reconstruction in old aged women

目的初步探讨高龄女性盆腔脏器脱垂手术方式和补片在重建盆底功能中的合理应用。方法我院妇科2004年3月～2010年6月期间共有21例老龄患者因盆腔器官脱垂应用补片进行手术和盆底重建。平均年龄76.8岁(70～89岁)。阴道前壁膨出21例,子宫脱垂18例,阴道后壁膨出11例。21例患者中18例行经阴道全子宫切除术,3例保留子宫。同时行阴道前后壁修补11例。单独植入阴道前壁补片18例,同时植入阴道前壁和后壁6例,尿道悬吊15例。结果21例患者总手术时间平均为116.2min(30-120min),其中放置补片的时间平均为20min,术中出血平均196mL(100-350mL)。术后恢复良好,术后住院时间5.4d(5-9d)。平均随访13.1个月(6-19个月),随访中发现1例补片侵蚀阴道粘膜,发生率为4.76%,为前壁补片。无补片感染发生。3例(14.3%)出现阴道前壁轻度膨出复发。结论补片在高龄女性盆底重建手术中的应用,方法简单,操作容易,手术时间短,老年患者耐受性好,补片放置方法需要术者掌握。

【Objective】 Toinvestigate the application of mesh in female pelvic reconstruction surgery.【Methods】 21 patients were underwent the operation for pelvic organ prolapse who were admitted from March 2004 to Jun 2010 in our department.Mesh was used for pelvic floor reconstruction in the operation.The average age was 76.8（70~89） years.The patients with the anterion vaginal wall prolapse 21 cases,with the uterine prolapsed were 18 cases,with the posterion vaginal wall prolapsed 11 cases.18 cases were performed vaginal hysterectomy;only 3 patients were conserved uterus.18 cases repaired anterion vaginal wall with mesh,.Both of the anterion and posterion vaginal wall were repaired with mesh in 6 cases cases,overhanging urethra 15 cases.【Results】 The mean operation time was 116.2min（30-120min）.The mean time of mesh placement was about 20 min only.The mean hemorrhage was 196mL（100-350mL）.All the patients were well-being after operation.The mean period of follow-up after operation was 13.1 moneh（6-19 months）.The erosion had happened in 1 case,and it incidence was 4.76%,was in anterion vaginal wall.No mesh infection was found.【Conclusion】 The application of mesh in female reconstruction surgery was easy and simple.Patient tolerance was well.