Objective To evaluate the effectiveness and safety of the entire pelvic floor reconstruction(Prolift) with uterus reserved in the treatment of pelvic floor dysfunction diseases.Methods From March 2008 to January 2009,...Objective To evaluate the effectiveness and safety of the entire pelvic floor reconstruction(Prolift) with uterus reserved in the treatment of pelvic floor dysfunction diseases.Methods From March 2008 to January 2009,74 female cases from our hospital who had different defects in pelvic organ prolapse were treated with the entire reconstructive pelvic surgery,in which 38 had uterus retained(observation group) and 36 cases had hysterectomy(control group).The two groups were compared.The patients with combined stress urinary incontinence had transobturator tension-free vaginal tape(TVT-O technique) at the same time.The results of operations were objectively evaluatedaccording to Pelvic Organ Prolapse Quantification sub-degree method(POP-Q) developed by the International Continence Society.Results For observation group,the average operative time was 50 min,and the average amount of bleeding was 100 mL.For control group,the average operative time was 110 min,and the average amount of bleeding was 200 mL.During the postoperative follow-up(8 ~18 months),in the observation group the structures of patients' pelvic floor were normal;stress urinary incontinence was all cured;related symptoms disappeared or were markedly improved;and no postoperative infection appeared.In control group,two cases had postoperative infection;the patients ' pelvic structures were normal during the postoperative follow-up;the related symptoms disappeared or were significantly improved.After 3 months,POP-Q score was significantly elevated in the two groups.Conclusion Full reconstructive pelvic surgery with uterus retained can complete the whole pelvic floor structure and function of all or part of the reconstruction with fast recovery and clear short-term effect.However,the long-term efficacy remains to be revealed.展开更多
Objective: To investigate the changes of inflammatory response, stress response and urodynamic changes after total pelvic floor reconstruction in patients with pelvic organ prolapse. Methods: According to random data ...Objective: To investigate the changes of inflammatory response, stress response and urodynamic changes after total pelvic floor reconstruction in patients with pelvic organ prolapse. Methods: According to random data table method, 80 cases of pelvic organ prolapse were randomly divided into the control group (n=40) and observation group (n=40), patients in the control group were given conventional vaginal hysterectomy plus vaginal wall repair sugery and the observation group received total pelvic floor reconstruction. The levels of the serum inflammatory factor,oxidative stress before and after surgery, and postoperative urodynamic changes were compared. Results: The levels of serum hs-CRP, IL-1β,TNF-α, NE, E and Ins in the two groups before treatment were not statistically significant. Compared with the group before treatment, the levels of hs-CRP, IL-1β, TNF-α, NE, E were significantly increased in both groups after treatment, and the observation group levels were significantly lower than those in the control group after treatment;in terms of urodynamics, the postoperative maximal bladder volume and Qmax were significantly higher in the observation group than in the control group, the postoperative levels of PdetQMax, PdetMax and PVR in the observation group were significantly lower than those in the control group. Conclusion: Compared with vaginal hysterectomy plus vaginal wall repair sugery, total pelvic floor reconstruction can light the patient's inflammation, stress response and improve the patient's urinary function, and the overall effect is better which has important clinical value.展开更多
BACKGROUND There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that ...BACKGROUND There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that exist with an operation indicate the importance of conservative treatment options prior to attempting surgery. Considering the prevalence of PFDs, it is important for primary care physician and specialists (obstetricians and gynecologists) to be familiar with the initial work-up and the available conservative treatment options prior to subspecialist (urogynecologist) referral. AIM To assess the types of treatments that specialists attempted prior to subspecialty referral and determine the differences in referral patterns. METHODS This is a retrospective cohort study of 234 patients from a community teaching hospital referred to a single female pelvic medicine and reconstructive surgery (FPMRS) provider for PFD. Specialist vs primary care provider (PCP) referrals were compared. Number, length and treatment types were studied using descriptive statistics. RESULTS There were 184 referrals (78.6%) by specialists and 50 (21.4%) by PCP. Treatment (with Kegel exercises, pessary placements, and anticholinergic medications) was attempted on 51%(n = 26) of the PCP compared to 48%(n = 88) of the specialist referrals prior to FPMRS referral (P = 0.6). There was no significant difference in length of treatment prior to referral for PCPs vs specialists (14 mo vs 16 mo, respectively, P = 0.88). However, there was a significant difference in the patient’s average time with the condition prior to referral (35 mo vs 58 mo for PCP compared to specialist referrals)(P = 0.02). CONCLUSION One half of the patients referred to FPMRS clinic received treatment prior to referral. Thus, specialists and generalists can benefit from education regarding therapies for PFD before subspecialty referral.展开更多
目的:探讨改良LeFort阴道封闭术与改良全盆底重建术对老年女性重度盆腔器官脱垂(pelvic organ prolapse,POP)的影响。方法:选取2016年2月17日—2021年2月17日贵州医科大学附属医院妇科收治的82例老年重度POP女性。根据随机抽签方式将其...目的:探讨改良LeFort阴道封闭术与改良全盆底重建术对老年女性重度盆腔器官脱垂(pelvic organ prolapse,POP)的影响。方法:选取2016年2月17日—2021年2月17日贵州医科大学附属医院妇科收治的82例老年重度POP女性。根据随机抽签方式将其分成对照组和试验组,各41例。对照组给予改良Le Fort阴道封闭术,试验组给予改良全盆底重建术。比较两组围手术期指标,相关指标,术前、术后半年临床症状及生活质量,术前、术后1周排尿、排便情况。结果:两组手术时间、住院时间、留置尿管时间、术中出血量比较,差异无统计学意义(P>0.05)。试验组治愈率高于对照组,复发率、新发压力性尿失禁发生率、再次手术发生率均低于对照组,差异有统计学意义(P<0.05)。术后半年,两组盆底功能障碍问卷(pelvic floor distress inventory-short form 20,PFDI-20)评分、盆底功能影响问卷简表(pelvic floor impact questionnaire--short form 7,PFIQ-7)评分降低,试验组PFDI-20评分、PFIQ-7评分均低于对照组,差异有统计学意义(P<0.05)。术后1周,试验组尿急、尿频、排尿困难、排便困难发生率均低于对照组,差异有统计学意义(P<0.05)。结论:改良全盆底重建术更有助于改善患者脱垂复发率,改善患者排尿、排便情况,手术十分安全有效。展开更多
文摘Objective To evaluate the effectiveness and safety of the entire pelvic floor reconstruction(Prolift) with uterus reserved in the treatment of pelvic floor dysfunction diseases.Methods From March 2008 to January 2009,74 female cases from our hospital who had different defects in pelvic organ prolapse were treated with the entire reconstructive pelvic surgery,in which 38 had uterus retained(observation group) and 36 cases had hysterectomy(control group).The two groups were compared.The patients with combined stress urinary incontinence had transobturator tension-free vaginal tape(TVT-O technique) at the same time.The results of operations were objectively evaluatedaccording to Pelvic Organ Prolapse Quantification sub-degree method(POP-Q) developed by the International Continence Society.Results For observation group,the average operative time was 50 min,and the average amount of bleeding was 100 mL.For control group,the average operative time was 110 min,and the average amount of bleeding was 200 mL.During the postoperative follow-up(8 ~18 months),in the observation group the structures of patients' pelvic floor were normal;stress urinary incontinence was all cured;related symptoms disappeared or were markedly improved;and no postoperative infection appeared.In control group,two cases had postoperative infection;the patients ' pelvic structures were normal during the postoperative follow-up;the related symptoms disappeared or were significantly improved.After 3 months,POP-Q score was significantly elevated in the two groups.Conclusion Full reconstructive pelvic surgery with uterus retained can complete the whole pelvic floor structure and function of all or part of the reconstruction with fast recovery and clear short-term effect.However,the long-term efficacy remains to be revealed.
文摘Objective: To investigate the changes of inflammatory response, stress response and urodynamic changes after total pelvic floor reconstruction in patients with pelvic organ prolapse. Methods: According to random data table method, 80 cases of pelvic organ prolapse were randomly divided into the control group (n=40) and observation group (n=40), patients in the control group were given conventional vaginal hysterectomy plus vaginal wall repair sugery and the observation group received total pelvic floor reconstruction. The levels of the serum inflammatory factor,oxidative stress before and after surgery, and postoperative urodynamic changes were compared. Results: The levels of serum hs-CRP, IL-1β,TNF-α, NE, E and Ins in the two groups before treatment were not statistically significant. Compared with the group before treatment, the levels of hs-CRP, IL-1β, TNF-α, NE, E were significantly increased in both groups after treatment, and the observation group levels were significantly lower than those in the control group after treatment;in terms of urodynamics, the postoperative maximal bladder volume and Qmax were significantly higher in the observation group than in the control group, the postoperative levels of PdetQMax, PdetMax and PVR in the observation group were significantly lower than those in the control group. Conclusion: Compared with vaginal hysterectomy plus vaginal wall repair sugery, total pelvic floor reconstruction can light the patient's inflammation, stress response and improve the patient's urinary function, and the overall effect is better which has important clinical value.
文摘BACKGROUND There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that exist with an operation indicate the importance of conservative treatment options prior to attempting surgery. Considering the prevalence of PFDs, it is important for primary care physician and specialists (obstetricians and gynecologists) to be familiar with the initial work-up and the available conservative treatment options prior to subspecialist (urogynecologist) referral. AIM To assess the types of treatments that specialists attempted prior to subspecialty referral and determine the differences in referral patterns. METHODS This is a retrospective cohort study of 234 patients from a community teaching hospital referred to a single female pelvic medicine and reconstructive surgery (FPMRS) provider for PFD. Specialist vs primary care provider (PCP) referrals were compared. Number, length and treatment types were studied using descriptive statistics. RESULTS There were 184 referrals (78.6%) by specialists and 50 (21.4%) by PCP. Treatment (with Kegel exercises, pessary placements, and anticholinergic medications) was attempted on 51%(n = 26) of the PCP compared to 48%(n = 88) of the specialist referrals prior to FPMRS referral (P = 0.6). There was no significant difference in length of treatment prior to referral for PCPs vs specialists (14 mo vs 16 mo, respectively, P = 0.88). However, there was a significant difference in the patient’s average time with the condition prior to referral (35 mo vs 58 mo for PCP compared to specialist referrals)(P = 0.02). CONCLUSION One half of the patients referred to FPMRS clinic received treatment prior to referral. Thus, specialists and generalists can benefit from education regarding therapies for PFD before subspecialty referral.
文摘目的:探讨改良LeFort阴道封闭术与改良全盆底重建术对老年女性重度盆腔器官脱垂(pelvic organ prolapse,POP)的影响。方法:选取2016年2月17日—2021年2月17日贵州医科大学附属医院妇科收治的82例老年重度POP女性。根据随机抽签方式将其分成对照组和试验组,各41例。对照组给予改良Le Fort阴道封闭术,试验组给予改良全盆底重建术。比较两组围手术期指标,相关指标,术前、术后半年临床症状及生活质量,术前、术后1周排尿、排便情况。结果:两组手术时间、住院时间、留置尿管时间、术中出血量比较,差异无统计学意义(P>0.05)。试验组治愈率高于对照组,复发率、新发压力性尿失禁发生率、再次手术发生率均低于对照组,差异有统计学意义(P<0.05)。术后半年,两组盆底功能障碍问卷(pelvic floor distress inventory-short form 20,PFDI-20)评分、盆底功能影响问卷简表(pelvic floor impact questionnaire--short form 7,PFIQ-7)评分降低,试验组PFDI-20评分、PFIQ-7评分均低于对照组,差异有统计学意义(P<0.05)。术后1周,试验组尿急、尿频、排尿困难、排便困难发生率均低于对照组,差异有统计学意义(P<0.05)。结论:改良全盆底重建术更有助于改善患者脱垂复发率,改善患者排尿、排便情况,手术十分安全有效。
