涤纶补片双悬吊固定治疗高龄直肠子宫双脱垂9例分析

Clinical Analysis of Double Suspension Fixation with Dacron Patch for Aged Patients with Rectal-uterine Prolapse

目的探讨涤纶补片双悬吊治疗高龄直肠子宫双脱垂的可行性与安全性。方法1995年1月～2012年10月收治直肠子宫双脱垂高龄患者9例，平均年龄82．7（78—90）岁，采用涤纶补片双悬吊法进行治疗。首先分离直肠上段后壁至直肠子宫凹陷平面，用7em×10em大涤纶补片包绕直肠后壁2／3肠腔并间断缝合固定在直肠壁上，将涤纶补片悬吊固定于骶胛前，再将双侧子宫角的输卵管及圆韧带缝扎上提固定在直肠前侧壁的补片上。结果本组术程平均出血30．4（20～50）瑚，平均手术时间1．8（1．5～2）h。术后所有患者均恢复良好，下床活动时间平均4．5（3—5）d，胃肠功能恢复时间平均3．5（2～4）d，术后平均住院时间7．5（6～11）d，术后7—9d伤口拆线后出院，围手术期无死亡病例。术后9例均获得随访，平均随访2．8（1—6）年。尿失禁经过术后功能锻炼均能自主排尿，患者生活质量明显改善，无复发，均未出现补片侵蚀肠管及子宫并发症。结论涤纶补片双悬吊治疗高龄直肠子宫双脱垂患者是一种安全有效的方法，值得临床推广应用。

Objective To discuss the feasibility and safety of double suspension fixation with Da- cron patch in the treatment of elderly patients with rectal-uterine prolapse. Methods A total of 9 patients suffered rectal-uterine prolapse, aged from 78 to 90 years with an average of 82.7 years, were trea- ted by double suspension fixation surgery with Dacron patch. Firstly, the upper rectal wall was isolated to the rectouterine concave plane. The 2/3 intestinal cavity of posterior wall of the rectum was encased with Dacron patch sized of 7 cm x 10 cm and interrupted suture fixated in the rectal wall. Then the Dacron patch was suspending fixation in the anterior sacral scapular area. After that, the fallopian tube and the round ligament of uterus of bilateral uterine horns were transfixed and fixated on the patch suspended in the anterolateral wall of rectum. Results The blood loss was 20 to 50 ml with an average of 30.4 ml during the operation, and the operative duration was 1.5 to 2 hours with an average of 1.8 hours. All cases were achieved good restoration, the time of out-of-bed activity was 3 to 5 days （ mean 4.5 days）, the recovery time of gastrointestinal function was 2 to 4 days （ mean 3.5 days）, and the time of postoperative hospital stays was 6 to 11 days （ mean 7.5 days）. Neither death of peri-operative duration nor serious complication of postoperation was found. All cases were followed up without recurrence during 1 to 6 years with an average of 2.8 years. Automatic micturition was restored after functional exercise and the quality of life was improved in all cases. Conclusion The surgical intervention of double suspension fixation with Dacron patch is a safe and effective method in treatment of patients with rectal-uterine prolapse, which is worthy of clinical application.