两种盆底修复系统在盆底重建手术治疗中的效果比较

Comparison of two kinds of pelvic floor repair systems in the treatment of pelvic floor reconstruction

目的探讨两种网片(Prolift全盆底重建系统和Gynemesh聚丙烯网片)在全盆底重建术的应用效果。方法盆腔脏器脱垂行全盆底重建术治疗患者50例,其中Prolift网片行全盆底重建术26例,Gynernesh网片行全盆底重建术24例。比较2组患者一般资料情况,围手术期包括手术时间、术中出血、术后尿残余量、术后住院时间等情况和随访术后POP-Q分期,检查术后恢复和阴道切口愈合情况、网片是否暴露、感染及丝线是否排异等有关并发症,术后是否有不适感及性生活异常状况,并进行统计学分析。结果2组患者年龄、绝经年龄和孕产次比较,差异无统计学意义(P>0.05);Prolift组患者平均年龄(61.38±8.13)岁,<Gynemesh组的(62.17±7.80)岁;Prolift组阴道前壁患者脱垂程度重于Gynemesh组(P<0.05),2组子宫脱垂和阴道后壁脱垂的程度差异无统计学意义(P>0.05)。Prolift组患者手术时间、术中出血、术后住院天数<Gynemesh组(P<0.05)。2组患者术后尿残余量比较差异无统计学意义(P>0.05)。2组随访率均达100%,Prolift组1例(3.8%)患者出现尿频、尿不净感,发生于术后3个月;Gynemesh组2例(8%)患者术后1年复发,其中阴道前壁脱垂Ⅱ度1例,阴道后壁脱垂Ⅱ度1例,2例复发患者同时伴有不同程度的尿不净、尿频或尿急等不适症状,1例(4%)患者出现网片暴露。结论Prolift和Gynemesh两种盆底脱垂系统均可用于全盆底重建手术,手术均安全有效,术后疗效和远期并发症方面Prolift要优于Gynemesh网片。

Objective To compare the application and short-term efficacy of two kinds of mesh(Prolift total pelvic floor reconstruction system and Gynemesh polypropylene mesh)in total pelvic floor reconstruction.Methods From January 2010 to July 2016,50 patients with pelvic organ prolapse were treated with the total pelvic floor reconstruction,including twenty-six patients underwent total pelvic floor reconstruction with Prolift total pelvic floor reconstruction system,and 24 patients underwent total pelvic floor reconstruction with Gynernesh polypropylene mesh.The general data,perioperative period including operation time,intraoperative bleeding,postoperative residual urine,postoperative hospital stay,and postoperative POP-Q stage were compared between the two groups.The postoperative recovery and vaginal incision healing,mesh exposure,infection,silk thread exclusion and other complications were examined.The discomfort and sexual life abnormality were also analyzed.Results There was no significant difference in age,menopause age and pregnancy and delivery times between the two groups(P>0.05),the average age of the Prolift group was(61.38±8.13)years old,which was less than that of the Gynemesh group(62.17±7.80)years old(P<0.05).The Prolift group had more prolapse in the anterior wallof the vagina than that of the Gynemesh group(P<0.05).There was no significant difference in the degree of uterine prolapse and vaginal posterior wall prolapse between the two groups(P>0.05).There was no significant difference in operation time,intraoperative bleeding,postoperative urine residual volume,and postoperative hospital stay between the two groups(P>0.05),the operation time in the Prolift group was shorter than that in the Gynemesh group(P<0.05).The follow-up rates of the two groups were 100%,and one case(3.8%)in the Prolift group showed urinary frequency and urinary impurity,which occurred 3 months after surgery.In Gynemesh group,two patients(8%)had recurrence,both one year after surgery,including one patient with grade II vaginal anterior wall prolapse,one patient with grade II vaginal posterior wall prolapse,two patients with recurrence were accompanied by discomfort symptoms,such as varying degrees of urinary incontinence,frequency of urination or urgency,and one patient(4%)showed mesh exposure.Conclusion Both Prolift and Gynemesh patches can be used in total pelvic floor reconstruction,and the surgery is safe and feasible.Prolift is superior to Gynemesh in terms of short-term efficacy and complications.