Prosima网片全盆底重建术治疗重度盆腔器官脱垂的前瞻性研究

Prospective study on total pelvic reconstruction surgery with Prosima in the treatment of pelvic organ prolapse stage III

目的探讨应用Prosima网片的全盆底重建术治疗重度盆腔器官脱垂（POP）的疗效及安全性。方法选择2010年7月至2011年12月北京协和医院妇产科收治的POP定量分度法（POP—Q）Ⅲ度POP患者31例，行Prosima网片全盆底重建术，其中2例因合并压力性尿失禁同时行经闭孔阴道无张力尿道中段悬吊带术（TVT—O）。记录患者围手术期情况。于术后1、6、12个月时对患者进行门诊随访，测量患者POP—Q各指示点位置，评价解剖学治愈率及并发症发生情况。通过盆底功能影响问卷简表（PFIQ-7）和POP尿失禁性生活问卷（PISQ-12）评估患者手术前、后生命质量和性生活质量改善情况。结果Prosima网片全盆底重建术手术时间（55±13）min，术中出血量（66±25）ml，术中无脏器损伤，也无需要输血的病例，所有患者均顺利恢复自主排尿，术后病率16％（5／31）。近期并发症3例，其中盆腔血肿2例，经保守治疗后治愈，1例为泌尿系统感染。患者术后中位随访时间为6个月（1～15个月），近期解剖学治愈率94％（29／31），另2例患者分别于术后3、12个月时复发，但不需再次手术治疗。PFIQ07术前中位评分50分，术后6个月和12个月中位评分均为0分，术后6和12个月与术前分别比较，差异均有统计学意义（P〈0．01）。PISQ-12评分术前为（30±6）分，术后12个月为（31±4）分，两者比较，差异无统计学意义（P=0．65）。16％（5／31）的患者发生网片暴露，无新发尿失禁和新发性交痛患者。结论Prosima网片全盆底重建术是一种安全、疗效满意的术式，可以明显改善患者的生命质量，对性生活质量无明显影响。

Objective To evaluate the safety and efficacy of total pelvic reconstruction surgery with Prosima in treatment of pelvic organ prolapse （POP） stage m. Methods From July 2010 to December 2011, 31 patients with POP stage m undergoing total pelvic reconstruction surgery with Prosima were enrolled in this prospective study. Among two cases complicated with stress urinary incontinence underwent transobturator tension-free vaginal tape concomitantly with total pelvic reconstruction surgery with Prosima. Clinical parameters during peri-operation were recorded and compared. Pelvic organ prolapse quantitative examination （POP-Q） and anatomic improvement in these patients after surgery were analyzed. Comparisons of pelvic floor impact questionnaire-short form 7 （ PFIQ-7 ） and pelvic organ prolapseurinary incontinence sexual questionnaire-short form 12 （PISQ-12） in these patients before and after surgery were used to evaluate quality of life and quality of sexual life. Results The mean operating time was （ 55 ＋- 13 ） minutes, mean blood loss was （66 ＋ 25 ） ml. No severe intraoperative complications were observed. All patients were able to recover spontaneous micturation within 5 days. Two cases experienced pelvic hematoma with diameters less than 7 cm, and resolved later. Another case was urinary tract infection. At the median follow-up 6 months （1 -15 months） , the rate of anatomic success defined as the leading vaginal edge above the hymen was 94% （29/31 ）. There were significant improvements in Aa, Ba, Ap, Bp, and C （ P 〈 0. 01 ） by POP-Q. Two patients showed recurrent prolapse at 3 months and 1 year after surgery, without the need of further operation. The median score of post-operative PFIQ-7 was 0 point at 6 months and 0 point at 12 months after operation, respectively, which were significantly lower than that of 50 points pre-operation （ P 〈 0. 01 ）. And there was no significant difference in the average score of PISQ-12 before and after surgery （30 ±6） points versus （31 ±4） points] （P 〉0. 05）. The rate of mesh exposure was 16% （5/31）, all the 5 eases occurred within 6 months and was cut in clinic. There was no case of de novo urinary incontinence and de novo dyspareunia. Conclusions Pelvic reconstruction surgery with Prosima is safe and efficacy in treatment of POP stage m. it could improve quality of life remarkably without influence on sexual quality of life.