猪小肠黏膜下层生物补片治疗盆腔器官脱垂的手术疗效分析

The clinical efficacy of porcine small intestinal submucosa for treating pelvic organ prolapse

目的探讨应用猪小肠黏膜下层生物补片(SIS)治疗盆腔器官脱垂(POP)的临床效果及并发症。方法回顾性分析2012年3月-2013年12月在北京大人民医院应用SIS行盆底重建手术的44例POP-Q≥Ⅱ期患者的临床资料。比较手术前后POP-Q各指示点位置及生活质量相关问卷(PFIQ-7、PFDI-20和PISQ-12)评分,分析术后患者的主客观复发率及下尿路症状。结果 44例患者随访时间为(2.4±0.7)年。术后患者主观复发率为6.8%(3/44),远低于客观复发率(36.4%,16/44)。术后未发生补片暴露。1例因尿潴留行补片缝线松解;1例阴道后壁补片植入部位感染,伴阴道疼痛,外用雌激素软膏后症状缓解;1例术后阴道前壁复发性脱垂Ⅲ期行Avaulta补片植入手术。患者PDFI-20评分由术前(66.25±28.35)分降为术后(17.03±21.00)分,PFIQ-7评分由术前(61.15±49.23)分降为术后(1.41±23.20)分,PISQ-12评分由术前(15.50±2.61)分降为术后(13.20±4.25)分。手术前后比较,除性生活质量评分外,差异均有统计学意义(P<0.05)。结论应用SIS对POP患者行盆底重建手术后,患者生活质量明显提高,性生活质量无明显变化。患者主观满意度高,并发症少。基于较高的阴道前壁脱垂复发率,需要特别注意阴道前壁的修补,远期效果尚待随访观察。

Objective To study clinical effect of porcine small intestinal submucosa（SIS）in treatment of pelvic organ prolapse（POP）.Methods From Mar.2012 to Dec.2013,44 patients with POP at more than Ⅱ of POP quantitation（POP-Q）staging system underwent pelvic reconstructive surgery with SIS in Peking University Peoples Hospital.The clinical data was analyzed retrospectively.The variable site of POP-Q staging system was compared between preoperative and postoperative status.Quality of life questionnaires of pelvic floor impact questionnaire（PFIQ-7）,pelvic floor distress inventory short form（PFDI-20）and the pelvic organ prolapse/urinary incontinence sexual questionnaire（PISQ-12）were also studied.We analyzed the subjective and objective recurrence,focusing on the lower urinary tract symptoms.Results The average follow-up time was（2.4±0.7）years.The subjective recurrent rate was 3/44（6.8%）,far lower than the objective recurrent rate（16/44,36.4%）.No erosion was observed on those patients.One patient underwent a mesh release procedure because of urinary retention.One had vaginal pain because of posterior vaginal wall infection where the mesh and the symptom was relieved by estrogen cream.One patient underwent a second surgery with Avaulta transvaginal mesh due to recurrence of stage 3anterior vaginal wall prolapse and the dysuria.Preoperative and postoperative score of PFDI-20,PFIQ-7and PISQ-12 was from 66.25±28.35 preoperatively to 17.03±21.00,61.15±49.23 and 1.41±23.20,15.50±2.61 and 13.20±4.25,respectively.The statistics were significant difference except the PISQ-12.Conclusions Postoperatively,the quality of life of patients with SIS repair was significantly improved.The sexual quality of life had no improvement.Less complication was observed.Anterior repair deserves more attention because of the higher anterior recurrent rate.Long-term clinical effects on patients should be warranted to follow-up.