阴道半封闭术治疗老年重度盆腔器官脱垂16例临床分析
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摘要
目的探讨阴道半封闭术治疗老年重度盆腔脏器脱垂(POP)的手术效果和安全性。方法回顾性分析安徽医科大学附属省立医院2008年1月至2016年10月行阴道半封闭术的老年重度POP病人16例的临床资料。年龄(77±6)岁,年龄范围为64～88岁,绝经时间(30. 19±6. 90)年,采用POP定量分度(POP-Q)分期,记录并分析围手术期各项参数、手术并发症,评价手术的客观、主观效果和病人满意度等。结果所有病人均安全度过围手术期,顺利恢复自主排尿。术后大部分病人排尿症状排便症状较前有所改善,病人平均住院费用为(9 048±2 501)元,住院天数(10. 3±3. 7) d,术后住院天数(4. 6±1. 3) d,术后客观治愈率100%,主观治愈率100%,病人满意度100%。结论阴道封闭术能缓解大多数POP病人现有的排尿排便症状,对无阴道性生活要求的老年重度POP病人是一种安全、经济、疗效满意的术式。
Objective To evaluate the efficacy and safety of partial colpocleisis in treating selected elderly patients with severe pelvic organ prolapse. Methods This was a retrospective case series of women who underwent colpocleisis from January 2008 to October 2011 in Anhui Provincial Hospital,Anhui Medical University. Sixteen patients with stage III and IV by POP-Q system were included,who with the mean age( 77 ± 6) years( 64-88 years) and the Menopause time( 30. 19 ± 6. 90) years( 14-42 years). The parameters of the preoperative period,surgical complications,evaluation of the objective,subjective effect and patient satisfaction. Results All patients went through the preoperative period safely and restored the spontaneous urination smoothly. Most patients had better urination symptom after the operations. The average hospitalization cost was( 9 048 ± 2 501) yuan,hospital days was( 10. 3 ± 3. 7) days,postoperative hospital stay was( 4. 6 ± 1. 3) days. After operation,the objective cure rate was 100%,the subjective cure rate was 100%,and the patient satisfaction was 100%. Conclusion Partial colpocleisis could cure pelvic organ prolapse and improve pelvic symptoms in most patients,which is a safer,economic,satisfied approach for sever POP elder patient without vaginal sexual requirement.
Objective To evaluate the efficacy and safety of partial colpocleisis in treating selected elderly patients with severe pelvic organ prolapse. Methods This was a retrospective case series of women who underwent colpocleisis from January 2008 to October 2011 in Anhui Provincial Hospital,Anhui Medical University. Sixteen patients with stage III and IV by POP-Q system were included,who with the mean age( 77 ± 6) years( 64-88 years) and the Menopause time( 30. 19 ± 6. 90) years( 14-42 years). The parameters of the preoperative period,surgical complications,evaluation of the objective,subjective effect and patient satisfaction. Results All patients went through the preoperative period safely and restored the spontaneous urination smoothly. Most patients had better urination symptom after the operations. The average hospitalization cost was( 9 048 ± 2 501) yuan,hospital days was( 10. 3 ± 3. 7) days,postoperative hospital stay was( 4. 6 ± 1. 3) days. After operation,the objective cure rate was 100%,the subjective cure rate was 100%,and the patient satisfaction was 100%. Conclusion Partial colpocleisis could cure pelvic organ prolapse and improve pelvic symptoms in most patients,which is a safer,economic,satisfied approach for sever POP elder patient without vaginal sexual requirement.
引文
[1]朱兰,王晓茜.阴道封闭术的历史及发展[J].现代妇产科进展,2011,20(7):505-507.
[2] ZELEKE BM,BELL RJ,BILLAH B,et al. Symptomatic pelvic floor disordersin community-dwelling older Australian women[J]. Maturitas,2016,85(1):34-41.
[3]王淑静,邓晓岚,陈德新,等.不同分娩方式对女性盆底功能影响的研究进展[J].中华临床医师杂志(电子版),2015,9(20):3768-3773. DOI:10. 3877/cma. j. issn. 1674-0785. 2015.20. 022.
[4]张新圆,万晓慧,古丽娜·阿巴拜克力.女性盆腔脏器脱垂患病危险因素分析[J].实用妇产科杂志,2010,26(5):369-371.
[5] ALLEN-BRADY K,CANNON-ALBRIGHT LA,FARNHAM JM,et al. Evidence for Pelvic Organ Prolapse Predisposition Genes on Chromosomes 10 and 17[J]. Am J Obstet Gynecol,2015,212(6):771. e1-e7. DOI:10. 1016/j. ajog. 2014. 12. 037.
[6] NERON M,FERRON G,VIEILLE P,et al. Treatment of neovaginal prolapse:case report and systematic review of the literature[J]. International Urogynecology Journal,2017,28(1):41-47.
[7] SM ITH FJ,H OLM AN CD,M OORIN RE,et al. Lifetime risk of undergoing surgery for pelvic organ prolapse[J]. Obstet Gynecol,2010,116:1096-1100.
[8]宋岩峰.老年盆腔器官脱垂的治疗原则及术式选择[J].中国实用妇科与产科杂志,2015,31(4):304-307.
[9]单倩倩,陶丽,颜士杰.女性压力性尿失禁的发病机制及治疗进展[J].安徽医药,2013,17(3):364-367.
[10]李江,刘上,陈伟康,等.塞来昔布在治疗压力性尿失禁中的疗效及安全性[J].昆明医科大学学报,2017,38(1):70-74.
[11]周婷婷,杨仕伟,王亮,等.盆腔器官脱垂对女性下尿路症状的影响[J].现代泌尿外科杂志,2016,21(9):687-690.
[12]丁曙睛.肛肠动力学检查在盆腔脏器脱垂病情评估中的应用及临床价值[J].中国医刊,2014,49(4):6-7.
[13]路畅,魏薇,卢丹.经阴道传统手术治疗盆腔脏器脱垂的复发情况及危险因素[J].中国临床医生杂志,2015,43(12):76-79.
[14]孙秀丽,王世言,申太峰,等.全盆底重建术后新发压力性尿失禁临床分析[J].中国妇产科临床杂志,2013,14(2):102-105.
[15]黄蓉,申志扬,喻红霞.四维超声诊断老年盆腔脏器脱垂及手术效果评估[J].中国老年学杂志,2017,37(6):1494-1495.
[16]阿依帕丽·艾克木江,古丽娜·阿巴拜克力.全盆底悬吊术治疗盆腔脏器脱垂的术后并发症研究进展[J].中华妇幼临床医学杂志(电子版),2016,12(1):83-87. DOI:10. 3877/cma. j.issn. 1673-5250. 2016. 01. 015.
[2] ZELEKE BM,BELL RJ,BILLAH B,et al. Symptomatic pelvic floor disordersin community-dwelling older Australian women[J]. Maturitas,2016,85(1):34-41.
[3]王淑静,邓晓岚,陈德新,等.不同分娩方式对女性盆底功能影响的研究进展[J].中华临床医师杂志(电子版),2015,9(20):3768-3773. DOI:10. 3877/cma. j. issn. 1674-0785. 2015.20. 022.
[4]张新圆,万晓慧,古丽娜·阿巴拜克力.女性盆腔脏器脱垂患病危险因素分析[J].实用妇产科杂志,2010,26(5):369-371.
[5] ALLEN-BRADY K,CANNON-ALBRIGHT LA,FARNHAM JM,et al. Evidence for Pelvic Organ Prolapse Predisposition Genes on Chromosomes 10 and 17[J]. Am J Obstet Gynecol,2015,212(6):771. e1-e7. DOI:10. 1016/j. ajog. 2014. 12. 037.
[6] NERON M,FERRON G,VIEILLE P,et al. Treatment of neovaginal prolapse:case report and systematic review of the literature[J]. International Urogynecology Journal,2017,28(1):41-47.
[7] SM ITH FJ,H OLM AN CD,M OORIN RE,et al. Lifetime risk of undergoing surgery for pelvic organ prolapse[J]. Obstet Gynecol,2010,116:1096-1100.
[8]宋岩峰.老年盆腔器官脱垂的治疗原则及术式选择[J].中国实用妇科与产科杂志,2015,31(4):304-307.
[9]单倩倩,陶丽,颜士杰.女性压力性尿失禁的发病机制及治疗进展[J].安徽医药,2013,17(3):364-367.
[10]李江,刘上,陈伟康,等.塞来昔布在治疗压力性尿失禁中的疗效及安全性[J].昆明医科大学学报,2017,38(1):70-74.
[11]周婷婷,杨仕伟,王亮,等.盆腔器官脱垂对女性下尿路症状的影响[J].现代泌尿外科杂志,2016,21(9):687-690.
[12]丁曙睛.肛肠动力学检查在盆腔脏器脱垂病情评估中的应用及临床价值[J].中国医刊,2014,49(4):6-7.
[13]路畅,魏薇,卢丹.经阴道传统手术治疗盆腔脏器脱垂的复发情况及危险因素[J].中国临床医生杂志,2015,43(12):76-79.
[14]孙秀丽,王世言,申太峰,等.全盆底重建术后新发压力性尿失禁临床分析[J].中国妇产科临床杂志,2013,14(2):102-105.
[15]黄蓉,申志扬,喻红霞.四维超声诊断老年盆腔脏器脱垂及手术效果评估[J].中国老年学杂志,2017,37(6):1494-1495.
[16]阿依帕丽·艾克木江,古丽娜·阿巴拜克力.全盆底悬吊术治疗盆腔脏器脱垂的术后并发症研究进展[J].中华妇幼临床医学杂志(电子版),2016,12(1):83-87. DOI:10. 3877/cma. j.issn. 1673-5250. 2016. 01. 015.