经阴道网片植入手术治疗盆腔器官脱垂的临床分析

Study on mesh-augmented vaginal reconstructive surgery in treatment of pelvic organ prolapse

目的评价经阴道网片植入手术治疗盆腔器官脱垂的疗效及并发症。方法2007年2月-2009年1月在北京大学第三医院因盆腔器官脱垂Ⅲ～Ⅳ度[据盆腔器官脱垂定量（POP—Q）分度法]采用经阴道网片植人手术的住院患者共66例，术后随访观察疗效指标，以主观症状和POP—Q测量评价主观和客观治愈率、复发率，以盆底不适调查表短表20（PFDI-20）评价手术前后患者的生命质量情况，并对并发症进行总结分析。结果66例患者中成功放置网片65例；术后随访率为97％（63／65），随访时间为17．2个月（12～25个月）。术后6个月、12个月时的主观、客观治愈率均为97％（61／63）。51例完成生命质量评价，PFDI-20评分术前、术后6个月、12个月分别为（102±50）、（16±21）和（15±20）分，手术前后比较，差异均有统计学意义（P〈0．05）。术中脏器损伤2例；术后复发2例，发生网片相关并发症4例，新发重度尿失禁1例。6例患者接受了二次手术，二次手术后症状缓解或治愈并无复发。结论经阴道网片植入手术治疗盆腔器官脱垂疗效好，术中并发症发生率低，网片相关并发症经二次手术处理后效果较好。

Objective To evaluate clinical outcome and complications of mesh-augmented vaginal reconstructive surgery in treatment of pelvic organ prolapse. Methods From Feb 2007 to Jan 2009, meshaugmented vaginal reconstructive surgery were performed on 66 women with pelvic organ prolapse stage Ⅲ - Ⅳ. Pre and postoperative symptoms, pelvic organ prolapse quantitation （POP-Q） stage and pelvic floor distress inventory-short form 20 （PFDI-20） measurements were studied to assess anatomic and quality-of-life outcome. Operative complications were also analyzed. Results Totally 65 patients underwent successful surgeries. The rate of follow-up was 97% （63/65） with a median follow-up of 17.2 months. Subjective cure rate and objective cure rate were both 97% （61/63） at 6 and 12 months after surgeries, 51 women completed PFDI-20 measurements and scores were 102 ±50 before surgery, 16 ±21 at 6 months and 15±20 at 12 months. It reaehed statistical difference when scores were compared before and after surgeries （P 〈 0. 05 ）. Among 66 patients, 2 patients underwent organ injuries, 2 had recurrent prolapse, 4 had mesh- related complications and 1 had severe de novo stress urinary incontinence. Six patients underwent second surgery. Conclusions Mesh-augmented vaginal reconstructive surgery in treatment of pelvic organ prolapsed brought satisfied clinical outcome. The incidence of mesh-related complications was low and secondary operative interventions were effective.