传统术式与经阴道网片盆底重建术在老年重度盆底器官脱垂患者的应用比较

Application of Transvaginal Reconstructive Pelvic Surgery with Polypropylene Mesh Compared with Traditionary Surgery in Old Patients with Severe Pelvic Organ Prolapse

目的评价传统术式与经阴道网片盆底重建术在老年重度盆底器官脱垂患者的应用及短期随访效果。方法回顾性分析52例重度盆底器官脱垂老年手术患者的临床资料,比较两种术式的优劣。结果传统术式及经阴道网片盆底重建术组(网片组)身体质量指数(BMI)、美国麻醉医师协会(ASA)分级、POPQ分期、病程无显著差异(P>0.05),而年龄和绝经时间有显著差异(P<0.05);传统术式组在手术时间、出血量、留置导尿时间及住院费用上明显少于网片组(P<0.001),住院时间无明显差异(P>0.05);PFIQ-7及PFDI-20问卷评分两种手术前后自身对比均有显著性差异(P<0.05),而术前及术后组间对比无显著性差异(P>0.05)。术后网片组出现1例患者尿潴留,各术式组出现1例膀胱过度活动症,术后1年网片组有2例发生网片侵蚀(9.1%)。结论传统手术相对经阴道网片盆底重建术创伤更小,短期满意率相当,无明显手术相关并发症,是老年无性要求重度盆底器官脱垂患者的一种安全、可靠、经济的术式。

Objective To evaluate the effect and short - term outcomes of transvaginal reconstructive pelvic surgery with polypropylene mesh and traditionary surgery for the treatment of in old patients with severe pelvic organ prolapse. Methods We retrospectively analyzed the clinical data of fifty - two old patients with severe pelvic organ prolapse who have undergone surgery in our department to compare the two procedures. Results Among 52 participants, there were no significant differences in pre - operative assessments include BMI, the score of ASA, the score of PFIQ -7 and PFDI -20, the stage of POPQ and course of disease （P 〉 O. 05 ） between the groups. Howev- er, the age of two group and years of menopause have significant differences（P 〈 0.05 ）. The traditionary surgery group had significantly reduced operative time, blood loss, days of urine indwelling catheter and the cost（P 〈 0. 001 ）. A high level of satisfaction with surgery and improvements in symptoms and quality - of- life data were observed at 12 months compared to baseline in both groups, but there was no significant difference. However, vaginal mesh exposure occurred in 2 women in the mesh group （9.1% ）. One woman suffered de uovo overactive bladder in each group and 1 woman experienced urinary retention for 7 days in mesh group. Conclusion In this study, the two procedures have similar surgical outcomes at short - term follow - up. Furthermore, traditionary surgery has less trauma and lower rates of surgical complications. It＇s a safe, reliable, economic and time -efficient procedures for old patients who has no desire for vaginal function with severe pelvic organ prolapse.