经阴网片置入后盆重建术治疗盆腔脏器脱垂的疗效分析

Efficacy of transvaginal posterior pelvic reconstruction with mesh in treatment of pelvic organ prolapse

目的探讨经阴单纯后盆重建术的有效性和安全性及其对前盆解剖的影响。方法回顾性分析2012年1月至2016年12月在四川大学华西医院行经阴单纯后盆重建术的20例患者手术前后主观症状和客观指标,按使用网片不同分为3组,Prolift网片6例(Porlift组),AMS网片9例(AMS组),Prolene网片5例(Prolene组),对各组患者术后疗效进行评估。结果随访时间(28.90±14.49)个月,3组患者Aa、Ba术后平均值较术前差异无统计学意义(P>0.05),Ap、Bp、C、D值较术前差异有统计学意义(P<0.05)。Prolift、AMS、Prolene组术后3个月和末次随访时主观疗效改善明显优于术前,差异具有统计学意义(P<0.05)。6例诉术后出现不适症状,术后新发3例阴道前壁脱垂。1例因阴道前壁网片暴露(外院手术)行网片取出术,结果显示后盆重建术对阴道前壁脱垂的影响(促进或改善)差异无统计学意义(P>0.05)。比较3种网片术后疗效,结果显示其主观和客观症状改善均有统计学意差异(P<0.05)。结论经阴网片置入后盆重建术是一种安全有效的手术方式,对患者阴道前壁脱垂的进展或改善无明显影响,AMS相比Prolene有更低的新发尿失禁发生率。

Objective The present study is to compare the effectiveness and safety of transvaginal posterior pelvic reconstruction and its effect on the untreated anterior vaginal wall. Methods A retrospective analysis concerning subjective and objective outcomes was made on 20 patients who underwent posterior pelvic reconstruction in West China Hospital of Sichuan University from January 2012 to December 2016. All patients were divided into 3 groups according to different mesh types,6 in Prolift group,9 in AMS group and 5 in Prolene group,and the curative effect on the patients in each group was assessed after operation. Results The duration of follow-up was（ 28. 90 ± 14. 49） months. It was found that for the 3 groups of patients,the postoperative mean value of Aa and Ba was of no statistical significance compared with that before operation（ P〉 0. 05）,while it was significantly improved in Ap,Bp,C,D postoperatively with statistically significant difference（ P 〈0. 05）.Among the 3 groups,the subjective efficacy of 3 months after surgery and the last follow-up were better than that before operation with statistically significant difference（ P〈 0. 05）. Improper symptoms occurred in 6 patients,and 3 cases of new anterior vaginal prolapse were observed.One patient had removed anterior mesh owing to exposure. It was indicated that the effect（ promotion or improvement） of transvaginal posterior pelvic reconstruction on anterior vaginal prolapse was not statistically significant（ P〉 0. 05）. This study showed that the subjective and objective outcomes were statistically improved among all three groups when treated with different types of meshes（ P〈 0. 05）. Conclusion Transvaginal posterior pelvic reconstruction with mesh in treatment of pelvic organ prolapse is considered to be an effective and safe procedure,and it has no significant effect on anterior vaginal prolapse. Additionally,AMS has a lower incidence of uroclepsia than Prolene.