生物补片在女性前盆腔器官重建手术中作用的临床研究

The clinical application of biological mesh in surgery of female anterior pelvic organ reconstruction

目的 探讨生物补片用于阴道前壁膨出修补术老年妇女的有效性和安全性. 方法 选取2010年1月至2013年10月于我院妇科行前盆腔器官重建手术患者68例,根据患者意愿分为采用生物补片修补术治疗阴道前壁膨出患者36例（生物补片组）和采用单纯改良阴道旁修补术治疗阴道前壁膨出患者32例（单纯改良组）,比较两组患者手术完成情况及其安全指标,并于术后1、3、6、12、24个月定期随访,对手术效果进行评价. 结果 所有患者阴道前壁膨出修补术均获成功,无手术并发症及死亡.生物补片组患者手术时间、术中出血量、术后保留尿管时间和术后住院时间分别为（88.1±18.3）min、（140.3±77.6） ml、（5.30±1.79）d、（5.53±2.00）d,与单纯改良组患者（88.0±17.4）min、（141.3±64.9） ml、（4.90±2.34）d、（5.50±2.08）d比较差异均无统计学意义（t=0.01、0.05、0.64、0.06,P=0.996、0.957、0.525、0.954）.按国际尿控协会采纳的盆腔器官脱垂定量系统（POP-Q）分期,36例生物补片修补术后患者未见复发;32例单纯改良修补术后患者复发4例（12.5％）,其中3例为Ⅱ期,1例为Ⅲ期,两组复发率差异有统计学意义（x2=4.79,P＜0.05）. 结论 生物源性补片用于阴道前壁及膀胱膨出修补术效果满意,方法简单且并发症少,与单纯改良阴道旁修补术比较不增加手术时间和术中出血量,且术后未见补片侵蚀及暴露发生.

Objective To explore the efficacy and safety of biological mesh during female anterior pelvic organ reconstruction.Methods The 68 consecutive women with symptomatic anterior vaginal wall prolapse in Beijing hospital from January 2010 to June 2013 were divided into two groups：6 cases underwent anterior vaginal wall repair with biological mesh,and 32 cases underwent vaginal approach to paravaginal repair.Preoperative and postoperative pelvic evaluations were performed with the POP-Q system.Patients were followed up at 1,3,6,12,24 months after operation.Objective cure was defined if the lateral sulci of the anterior vaginal walls were at grade 0 and firmly apposed to the lateral pelvic sidewalls.Results Among 68 patients,38 had grade Ⅲ and 30 had grade Ⅳ anterior vaginal wall prolapse.In all patients the anterior vaginal repair was performed successfully.The indexes of operation time,amount of bleeding,the postoperative retention time of catheter and hospital stay had no difference between biological mesh and vaginal approach groups [（88.1±18.3）min vs.（88.0±17.4）min,（140.3±77.6） ml vs.（141.3±64.9） ml,（5.30±1.79） d vs.（4.90±2.34） d,（5.53±2.00）d vs.（5.50±2.08）d,t=0.01,0.05,0.64,0.06,respectively,all P〉0.05].No complication happened during and after operation.No one relapsed in biological mesh group and 4 cases relapsed in paravaginal repair group.The relapse rate between two groups is statistically different（x2 =4.79,P〈0.05）.Conclusions The anterior vaginal repair with biological mesh is effective during female anterior pelvic organ reconstruction,but the long-term outcome of biological mesh in pelvic floor construction needs further study.