盆底重建术治疗盆腔器官脱垂短期主客观疗效分析

The analysis of objective and subjective short-time curative effect on total pelvic floor reconstruction to pelvic floor prolapse patients

目的探讨应用网片的全盆底重建术治疗盆腔器官脱垂的疗效。方法应用主观及客观评分法对中国医科大学附属盛京医院2007年7月至2009年7月收治的盆腔器官脱垂、需要手术治疗的78例患者进行评分。研究组58例采用应用网片的全盆底重建术;对照组20例应用阴式全子宫切除及阴道前后壁修补。结果 (1)术后3～6个月门诊复查,研究组未见术后复发,POP评分法测定各指示点均在正常位置,客观治愈率达100%。主观症状评分改善24.59±2.28,6例患者术后仍有轻度尿频症状及轻度压力性尿失禁(SUI)症状,主观治愈率89.7%。对照组术后复发Ⅱ度4例,客观治愈率80%。主观症状评分改善18.30±3.68,主观症状复发9例,包括盆腔、肠道及膀胱症状,主观治愈率55%。两组治愈率比较差异有统计学意义(P<0.05)。(2)对于同时合并SUI患者,研究组通过应用经闭孔尿道中段悬吊术(TVT-O)或前路网片提升等办法,使其均得治愈,对照组中未行TVT-O手术者症状无明显改善,1例出现隐匿性SUI症状,主观症状评分改善较小。结论应用替代材料的全盆底重建术对于恢复女性盆底器官解剖结构及改善盆底功能障碍症状方面的疗效肯定。

Objective To discuss the curative effect of Total Pelvic Floor Reconstruction with mesh match on severe pel- vic floor prolapse patients. Methods Graded the 78 cases of pelvic floor prolapse patients with objective and subjective grade methods in our hospital between Jul. ,2007 and Jul. ,2009,58 cases in experimental group were cured by Total Pel- vic Floor Reconstruction with mesh patch. 20 patients in the control group cured by vaginal hysterectomy with the repair of anterior and posterior vaginal wall. Results 1. By 3 to 6 month-follow-up after operation,there was no recidivate case in experiment group, they scored by POP-Q were all 0 grade, objective cure rate is 100%. The mean subjective symptom score improves 24. 59± 2. 28. The symptom of pelvic and intestinal tract were all cured. There were 6 cases still had the symptom of frequent and mild SUI. Subjective cure rate is 89. 7% ;There were 4 cases of 11 grade in the control group af- ter operation,they were vagina anterior wall and vagina fornix bulge, objective cure rate is 80%. The mean subjective symptom score improves 18.30±3.68 ,There were 9 cases still had the symptom of pelvic,intestinal tract and bladder symptom. Subjective cure rate is 55%. There were significantly different on cure rate and subjective symptom score im- provement between the two group（ P 〈0. 05 ）. 2. Cases of experiment group who suffered from SUI were cured by TVT-O or by ascending the front mesh. In control group who suffered from SU1,3 cases were cured by TVT-O and other 2 cases did not heal. Other 1 case has new symptom of SUI after operation. Conclusion Total Pelvic Floor Reeonstruction which used vicarious materials has certain curative effect for recovering the anatomy of pelvic floor and improve the symptom of pelvic dysfunction.