Prolift系统盆底重建术与常规阴式手术治疗盆腔器官脱垂的临床分析

Clinical analysis on pelvic organ prolapse treated by pelvic floor reconstruction surgery with Prolift system and routine transvaginal surgery

目的比较Prolift系统盆底重建术与常规阴式手术治疗盆腔器官脱垂的临床疗效。方法回顾性分析2009年6月至2011年3月重庆医科大学附属第一医院收治入院的盆腔器官脱垂患者64例,将其分为Prolift系统盆底重建组(重建组)32例和阴式子宫切除加阴道前后壁修补术组(常规组)32例,比较两组患者一般情况、围术期及随访资料,并进行统计学处理,分析其手术效果。结果两组患者的年龄、体质量指数、绝经年龄、孕产次及子宫脱垂程度差异均无统计学意义(P>0.05),所有患者手术均获成功,均未出现严重的术后并发症。重建组患者在术中出血量、平均手术时间、肛门排气时间、术后最高体温、留置尿管天数以及术后住院天数等指标上均明显优于常规组(P<0.05)。重建组随访率93.8%(30/32),术后1例(3.1%)复发,1例(3.1%)补片侵蚀,1例(3.1%)新发下尿路症状,19例恢复性生活者,1例性交痛,2例性交不适感;常规组随访率90.6%(29/32),术后8例(25%)复发,4例(12.5%)新发下尿路症状,16例恢复性生活者,3例性交痛,5例性交不适感。术后3个月及6个月两组间客观治愈率比较差异无统计学意义(P>0.05);术后12个月两组间客观治愈率比较差异有统计学意义(P<0.05),重建组客观治愈率高于常规组。结论 Prolift系统盆底重建术较常规阴式手术在治疗盆腔脏器脱垂中能更好地恢复盆底解剖结构和功能,手术创伤小,短期安全有效,但远期疗效仍需进一步研究。

Objective To investigate the clinical effectiveness of pelvic floor reconstruction surgery with Prolift system and rou‐tine transvaginal surgery in treating pelvic organ prolapse （POP） .Methods We analyzed an retrospective study of 64 patients with POP patients from June 2009 to March 2011 .All patients were divided into two groups ,32 cases of the reconstruction group were treated with pelvic floor reconstruction surgery with Prolift system ,as reconstruction group ,the other 32 cases in routine treatment group with routine transvaginal surgery ,which inclouded transvaginal hysterectomy ,repair of anterior and posterior vaginal wall ,as routine treatment group ,the pre operative ,peri operative data and follow up results were compared between the two groups and to evaluate the outcomes of the two groups after surgery .Results The age ,body mass index ,menopause age ,pregnant times and the degree of uterus prolapse were no significant difference between the two groups （P〉0 .05） .The operation of all the patients were successful .No patient were infected after surgery ,no vascular injury ,or urinary system injury ,or rectal injury occurred .Reconstruc‐tion group showed more significant in the amounts of blood loss ,average operation time ,anal exsufflation time ,mean of highest postoperative body temperature ,the urinary canal indwelling time and the postoperative hospitalization time compared with routine treatment group（P〈0 .05） .The follow up rate was 93 .8% （30/32）in reconstruction group ,1 patient （3 .1% ）experienced recur‐rence ,1 patient（3 .1% ）experienced mesh erosion ,1 patient（3 .1% ） experienced new urinary tract symptoms ,of 19 patients who were sexually active ,1 patient suffered from algopareunia and 2 from sexual intercourse discomfort respectively .The follow up rate was 90 .6% （29/32）in routine treatment group ,4 patients（12 .5% ）experienced new urinary tract symptoms ,8 patients（25% ）expe‐rienced recurrence ,of 16 patients who were sexually active ,3 patients suffered from algopareunia and 5 from sexual intercourse dis‐comfort .The objective cure rates at 3 and 6 months after operation was no significant difference between the two groups （P〉0 .05） ,but the objective cure rate at 12 months after operation was significantly different between the two groups （P〈0 .05） .The objective curative rate in reconstruction group was significantly higher than that in routine treatment group .Conclusion Pelvic floor reconstruction surgery with Prolift system is a safe and effective methods of minimally invasive surgery ,patients had better regain integrity of anatomical structure and functions of pelvic floor in short term for POP when compared with routine transvaginal sur‐gery ,but its long term study is still needed .