BACKGROUND Internal rectal prolapse(IRP)is one of the most common causes of obstructive constipation.The incidence of IRP in women is approximately three times that in men.IRP is mainly treated by surgery,which can be...BACKGROUND Internal rectal prolapse(IRP)is one of the most common causes of obstructive constipation.The incidence of IRP in women is approximately three times that in men.IRP is mainly treated by surgery,which can be divided into two categories:Abdominal procedures and perineal procedures.This study offers a better procedure for the treatment of IRP.AIM To compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair(IPFLR)combined with a procedure for prolapse and hemorrhoids(PPH)and the laparoscopic IPFLR alone in the treatment of IRP in women.METHODS This study collected the clinical data of 130 female patients with IRP who underwent surgery from January 2012 to October 2014.The patients were divided into groups A and B.Group A had 63 patients who underwent laparoscopic IPFLR alone,and group B had 67 patients who underwent the laparoscopic IPFLR combined with PPH.The degree of internal rectal prolapse(DIRP),Wexner constipation scale(WCS)score,Wexner incontinence scale(WIS)score,and Gastrointestinal Quality of Life Index(GIQLI)score were compared between groups and within groups before surgery and 6 mo and 2 years after surgery.RESULTS All laparoscopic surgeries were successful.The general information,number of bowel movements before surgery,DIRP,GIQLI score,WIS score,and WCS score before surgery were not significantly different between the two groups(all P>0.05).The WCS score,WIS score,GIQLI score,and DIRP in each group 6 mo,and 2 years after surgery were significantly better than before surgery(P<0.001).In group A,the DIRP and WCS score gradually improved from 6 mo to 2 years after surgery(P<0.001),and the GIQLI score progressively improved from 6 mo to 2 years after surgery(P<0.05).In group B,the DIRP,WCS score and WIS score significantly improved from 6 mo to 2 years after surgery(P<0.05),and the GIQLI score 2 years after surgery was significantly higher than that 6 mo after surgery(P<0.05).The WCS score,WIS score,GIQLI score,and DIRP of group B were significantly better than those of group A 6 mo and 2 years after surgery(all P<0.001,Bonferroni)except DIRP at 2 years after surgery.There was a significant difference in the recurrence rate of IRP between the two groups 6 mo after surgery(P=0.011).There was no significant difference in postoperative grade I-III complications between the two groups(P=0.822).CONCLUSION Integral theory–guided laparoscopic IPFLR combined with PPH has a higher cure rate and a better clinical efficacy than laparoscopic IPFLR alone.展开更多
A 91-year-old female presented with a pulsatile abdominal mass. Her past medical history included hypertension and hyperlipidemia. A 6.9 cm infrarenal abdominal aortic aneurysm, with a left ectopic pelvic kidney and t...A 91-year-old female presented with a pulsatile abdominal mass. Her past medical history included hypertension and hyperlipidemia. A 6.9 cm infrarenal abdominal aortic aneurysm, with a left ectopic pelvic kidney and two aberrant renal arteries, one each from the left and right common iliac arteries was found on computed tomography. Because of the high risk of rupture, surgery was recommended and an endovascular aneurysm repair was performed. The antegrade flow of the aberrant renal artery from the left common iliac artery was preserved. The right aberrant renal artery was covered with stent graft. The patient’s serum creatinine level remained unchanged throughout the postoperative course, with an uneventful postoperative recovery.展开更多
A 75-year-old woman complained of anuria and a sense of discomfort with severe pelvic organ prolapse (POP). We planned tension-free vaginal mesh (TVM) surgery after curing mucosal defects and completing treatment for ...A 75-year-old woman complained of anuria and a sense of discomfort with severe pelvic organ prolapse (POP). We planned tension-free vaginal mesh (TVM) surgery after curing mucosal defects and completing treatment for diabetes mellitus. Anuria and pyelonephritis relapsed repeatedly due to the failure of ring pessary therapy. Surgical treatment was required emergently. We performed a total laparoscopic hysterectomy and uterosacral ligament colpo-suspension (Shull’s method). Although the vaginal apex was supported to a good position, cystocele occurred six months after the initial surgery. A TVM procedure for recurrent cystocele was performed after curing the mucosal defects, and after the improvement of glycemic control. Transvaginal native tissue repair has the advantages of low risk of ureter injury, firm colpo-suspension, and no need for mesh usage. On the other hand, it is not good at treating cystocele. Transvaginal native tissue repair should prove to be a useful surgical option for apical support without mesh.展开更多
目的观察Prolift盆底重建术治疗重度盆腔器官脱垂(pelvic organ prolapse,POP)的临床效果及预后影响因素。方法回顾性分析2015年1月—2018年5月行Prolift盆底重建术治疗的214例重度POP的临床资料,记录手术及随访情况,观察临床疗效,评价...目的观察Prolift盆底重建术治疗重度盆腔器官脱垂(pelvic organ prolapse,POP)的临床效果及预后影响因素。方法回顾性分析2015年1月—2018年5月行Prolift盆底重建术治疗的214例重度POP的临床资料,记录手术及随访情况,观察临床疗效,评价术前、术后1年标准盆腔器官脱垂定量(pelvic organ prolapse quanfitafion,POP-Q)分度、盆底功能障碍问卷-20(pelvic floor distress inventory-short form-20,PFDI-20)评分、盆腔器官脱垂/尿失禁性生活问卷-12(pelvic organ prolapse/urinary incontinence sexual questionnaire short form-12,PISQ-12)评分。根据临床疗效,将客观治愈者及主观治愈者作为预后良好组,将无效者及复发者作为预后不良组,采用多因素logistic回归分析探究影响重度POP患者预后的危险因素。结果214例手术时间为69~112(86.28±10.16)min;术中出血量71~124(98.46±15.42)ml;术后阴道壁长度≥5 cm 94例,<5 cm 120例。8例术后出现网片暴露侵蚀情况,经对症处理后症状消失。随访1年,预后良好组186例,预后不良组28例,总治愈率86.92%。214例重度POP术后1年POP-Q分度、PFDI-20评分较术前降低,PISQ-12评分较术前升高,差异有统计学意义(P<0.01)。多因素logistic回归分析显示,体质量指数≥24.00 kg/m 2、术前POP-Q分度Ⅳ度、脱垂部位为前盆腔、术后阴道壁长度≥5 cm是影响重度POP患者预后的独立危险因素(P<0.05或P<0.01)。结论Prolift盆底重建术治疗重度POP临床疗效显著,明显改善了患者生活质量,并且积极对体质量指数≥24.00 kg/m 2、术前POP-Q分度Ⅳ度、脱垂部位为前盆腔、术后阴道壁长度≥5 cm的重度POP患者进行干预可有效改善预后。展开更多
基金Supported by Medical Science and Technology Project of Henan Province,China,No.2011030031.
文摘BACKGROUND Internal rectal prolapse(IRP)is one of the most common causes of obstructive constipation.The incidence of IRP in women is approximately three times that in men.IRP is mainly treated by surgery,which can be divided into two categories:Abdominal procedures and perineal procedures.This study offers a better procedure for the treatment of IRP.AIM To compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair(IPFLR)combined with a procedure for prolapse and hemorrhoids(PPH)and the laparoscopic IPFLR alone in the treatment of IRP in women.METHODS This study collected the clinical data of 130 female patients with IRP who underwent surgery from January 2012 to October 2014.The patients were divided into groups A and B.Group A had 63 patients who underwent laparoscopic IPFLR alone,and group B had 67 patients who underwent the laparoscopic IPFLR combined with PPH.The degree of internal rectal prolapse(DIRP),Wexner constipation scale(WCS)score,Wexner incontinence scale(WIS)score,and Gastrointestinal Quality of Life Index(GIQLI)score were compared between groups and within groups before surgery and 6 mo and 2 years after surgery.RESULTS All laparoscopic surgeries were successful.The general information,number of bowel movements before surgery,DIRP,GIQLI score,WIS score,and WCS score before surgery were not significantly different between the two groups(all P>0.05).The WCS score,WIS score,GIQLI score,and DIRP in each group 6 mo,and 2 years after surgery were significantly better than before surgery(P<0.001).In group A,the DIRP and WCS score gradually improved from 6 mo to 2 years after surgery(P<0.001),and the GIQLI score progressively improved from 6 mo to 2 years after surgery(P<0.05).In group B,the DIRP,WCS score and WIS score significantly improved from 6 mo to 2 years after surgery(P<0.05),and the GIQLI score 2 years after surgery was significantly higher than that 6 mo after surgery(P<0.05).The WCS score,WIS score,GIQLI score,and DIRP of group B were significantly better than those of group A 6 mo and 2 years after surgery(all P<0.001,Bonferroni)except DIRP at 2 years after surgery.There was a significant difference in the recurrence rate of IRP between the two groups 6 mo after surgery(P=0.011).There was no significant difference in postoperative grade I-III complications between the two groups(P=0.822).CONCLUSION Integral theory–guided laparoscopic IPFLR combined with PPH has a higher cure rate and a better clinical efficacy than laparoscopic IPFLR alone.
文摘A 91-year-old female presented with a pulsatile abdominal mass. Her past medical history included hypertension and hyperlipidemia. A 6.9 cm infrarenal abdominal aortic aneurysm, with a left ectopic pelvic kidney and two aberrant renal arteries, one each from the left and right common iliac arteries was found on computed tomography. Because of the high risk of rupture, surgery was recommended and an endovascular aneurysm repair was performed. The antegrade flow of the aberrant renal artery from the left common iliac artery was preserved. The right aberrant renal artery was covered with stent graft. The patient’s serum creatinine level remained unchanged throughout the postoperative course, with an uneventful postoperative recovery.
文摘A 75-year-old woman complained of anuria and a sense of discomfort with severe pelvic organ prolapse (POP). We planned tension-free vaginal mesh (TVM) surgery after curing mucosal defects and completing treatment for diabetes mellitus. Anuria and pyelonephritis relapsed repeatedly due to the failure of ring pessary therapy. Surgical treatment was required emergently. We performed a total laparoscopic hysterectomy and uterosacral ligament colpo-suspension (Shull’s method). Although the vaginal apex was supported to a good position, cystocele occurred six months after the initial surgery. A TVM procedure for recurrent cystocele was performed after curing the mucosal defects, and after the improvement of glycemic control. Transvaginal native tissue repair has the advantages of low risk of ureter injury, firm colpo-suspension, and no need for mesh usage. On the other hand, it is not good at treating cystocele. Transvaginal native tissue repair should prove to be a useful surgical option for apical support without mesh.
文摘目的观察Prolift盆底重建术治疗重度盆腔器官脱垂(pelvic organ prolapse,POP)的临床效果及预后影响因素。方法回顾性分析2015年1月—2018年5月行Prolift盆底重建术治疗的214例重度POP的临床资料,记录手术及随访情况,观察临床疗效,评价术前、术后1年标准盆腔器官脱垂定量(pelvic organ prolapse quanfitafion,POP-Q)分度、盆底功能障碍问卷-20(pelvic floor distress inventory-short form-20,PFDI-20)评分、盆腔器官脱垂/尿失禁性生活问卷-12(pelvic organ prolapse/urinary incontinence sexual questionnaire short form-12,PISQ-12)评分。根据临床疗效,将客观治愈者及主观治愈者作为预后良好组,将无效者及复发者作为预后不良组,采用多因素logistic回归分析探究影响重度POP患者预后的危险因素。结果214例手术时间为69~112(86.28±10.16)min;术中出血量71~124(98.46±15.42)ml;术后阴道壁长度≥5 cm 94例,<5 cm 120例。8例术后出现网片暴露侵蚀情况,经对症处理后症状消失。随访1年,预后良好组186例,预后不良组28例,总治愈率86.92%。214例重度POP术后1年POP-Q分度、PFDI-20评分较术前降低,PISQ-12评分较术前升高,差异有统计学意义(P<0.01)。多因素logistic回归分析显示,体质量指数≥24.00 kg/m 2、术前POP-Q分度Ⅳ度、脱垂部位为前盆腔、术后阴道壁长度≥5 cm是影响重度POP患者预后的独立危险因素(P<0.05或P<0.01)。结论Prolift盆底重建术治疗重度POP临床疗效显著,明显改善了患者生活质量,并且积极对体质量指数≥24.00 kg/m 2、术前POP-Q分度Ⅳ度、脱垂部位为前盆腔、术后阴道壁长度≥5 cm的重度POP患者进行干预可有效改善预后。
