硅胶子宫托治疗盆腔脏器脱垂临床观察

Silicone pessary treatment of pelvic organ prolapse

目的探讨应用硅胶子宫托治疗盆腔脏器脱垂。方法 2005年11月至2009年3月北京大学第三医院,对硅胶子宫托治疗有症状的POP-Q分期Ⅲ～IV期盆腔脏器脱垂患者52例,进行使用方法、使用时间有无合并症的随访,并填写生活质量调查问卷(PFDI-20短表)。采用配对资料秩和检验统计分析。结果 2005年11月至2009年3月有52例患者试戴硅胶子宫托,33例(63.46%)患者试戴成功。随访31/33例(93.94%),其中23/31例(74.2%)自行取放子宫托;取放间隔时间约1d至6月,28/31例(90.32%)<1月。除1例网片添加盆底重建术术后复发后配戴子宫托患者出现网片侵蚀和阴道壁脓肿外,无严重合并症发生。随访中8/31例(25.81%)放弃使用子宫托,其中7/8在1年内放弃。放弃的主要原因为子宫托大小不合适、取放麻烦或困难。持续使用者随访时间为(10.04±2.57)个月(3～17个月)。27例(含5例放弃者)完成生活质量调查问卷。PFDI-20上托前中位评分为36.16分,上托后为25.98分,差异有统计学意义(P<0.05)。结论硅胶子宫托治疗重度盆腔脏器脱垂安全、有效,可以显著改善患者的生存质量。不能坚持使用的主要原因为患者的依从性不高。

Objective To determine the optimal management of silicone pessary treatment for pelvic organ prolapse. Methods Between November 2005 and March 2009, 52 women with pelvic organ prolapse （POPQ stage Ill - IV ） wished to use silicone pessary in our department were studied. Women fitted with pessary completed the Pelvic Floor Dis- tress Inventory-20 （PFDI-20） before and after initiating pessary use. Results 33 of 52 （63.46%）patients received pessary. 31 of 33 （ 93.94% ） patients were followed up. 23 of 31 patients （74. 2% ） removed＂ the pessary by themselves, and 28 of 31 （90. 32% ）within one-month intervals. Only one serious complication was vaginal wall abscess at a recurrent patient post reconstructive surgery with mesh. 8 of 31 （25.81% ）patients quit to use pessary and 87. 5 % （7/8） quit within one year. The main reason for discontinue use was unsuccessful fitting and difficuh to removal. The mean follow-up time of pessary continuation was （ 10. 04 ± 2. 57） m （3 - 17m）. 27 women, including 5 discontinued patients, completed the PFDI - 20 Questionnaires. PFDI-20 score was 36. 16 before pessary use. It significantly decreased to 25.98 after the pessary use （P 〈 O. 05 ）. Conclusions Silicone pessary is a feasible conservative treatment option for pelvic organ pro- lapse. It presents good effect on improving the short term quality of life in patients. A rigorous follow-up system must be established.