盆底重建术后阴道聚丙烯网片暴露对患者生命质量的影响

Impact of vaginal mesh exposure on quality of life in patients undergoing transvaginal reconstructive pelvic surgery with polypropylene mesh

目的探讨盆底重建术后阴道聚丙烯网片暴露对重度盆腔器官脱垂患者生命质量的影响。方法2004年5月至2011年3月解放军总医院第一附属医院妇产科采用经阴道聚丙烯网片盆底重建术治疗重度盆腔器官脱垂患者114例，分别于术后2、6及12个月时进行随访，并根据有无阴道网片暴露分为暴露组和非暴露组。采用盆底功能障碍问卷简表（PFDI-20）以及盆底功能影响问卷简表（PFIQ-7）对两组患者的生命质量进行评价。结果术后2个月共96例患者获得随访，其中暴露组19例，非暴露组77例，网片暴露率19．8％（19／96）；术后6个月共85例患者获得随访，其中暴露组13例，非暴露组72例，网片暴露率15．3％（13／85）；术后12个月共77例患者获得随访，其中暴露组6例，非暴露组71例，网片暴露率7．8％（6／77）。暴露组术前PFDI-20与PFIQ-7评分分别为39．6、57．1分，术后2个月分别为8．3、9．5分，术后6个月分别为8．3、9．5分，术后12个月分别为2．1、0分，手术后各时间点分别与术前比较，差异均有统计学意义（P〈0．01）。非暴露组术前PFDI-20与PFIQ-7评分分别为54．2、66．7分，术后2个月分别为8．3、4．8分，术后6个月和12个月均为0分，与暴露组手术前、后各时间点分别比较，差异均无统计学意义（P〉0．05）。结论经阴道聚丙烯网片盆底重建术后发生阴道网片暴露较为常见，但并不显著影响患者的生命质量。

Objective To study the impact of vaginal mesh exposure on quality of life in patients undergoing transvaginal reconstructive pelvic surgery （RPS） with polypropylene mesh. Methods From May 2004 to March 2011,114 patients with severe pelvic organ prolapse（POP） undergoing transvaginal RPS with polypropylene mesh were enrolled in this study, which were divided into exposure and non-exposure group according to appearing vaginal mesh exposure at 2 months, 6 months and 1 year after operation. At the same time, pelvic floor distress inventory short form 20 （PFDI-20） and pelvic floor impact questionnaire short form 7 （ PFIQ-7 ） were completed in those patients. Results At 2 months after operation, 96 patients were tollowed up, including 19 patients in exposure group and 77 patients in non-exposure group, and the rate of exposure was 19.8% （19/96）; At 6 months after operation, 85 patients were followed up, including 13 patients in exposure group and 72 patients in non-exposure group, and the rate of exposure was 15.3% （ 13/85 ） ; At 1 year after operation,77 patients were followed up, including 6 patients in exposure group and 71 patients in non-exposure group, and the rate of exposure was 7.8% （6/77）. Mean score of PFDI-20 and PFIQ-7 in exposure group before operation was 39. 6 and 57. 1, which was statistically improved to 8.3 and 9.5 at 2 months after operation,8. 3 and 9. 5 at 6 months after operation,2. 1 and 0 in i year after operation （P 〈0. 01 ）. Mean score of PFDI-20 and PFIQ-7 of non-exposure group before operation was 54. 2 and 66.7,which was improved to 8.3 and 4. 8 at 2 months after operation, 0 at 6 months and 1 year after operation, but there was no significant difference in mean score of PFDI-20 and PFIQ-7 between the two groups （ P 〉 0. 05 ） . Conclusion Vaginal mesh exposure was common after transvaginal RPS with polypropylene mesh, however, most of them were moderate, and there was no significant impact on patients＇ qualifies of life.