全盆底重建术治疗227例女性盆腔脏器脱垂疗效分析
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摘要
目的分析盆底重建术治疗盆腔脏器脱垂(POP)的临床疗效。方法选取2012年1月‐2015年12月于该院因POP II-IV接受经阴盆底重建手术(TVM)的患者227例,分析患者盆腔脏器脱垂定量分期法(POP-Q评分)、盆底功能障碍问卷-20(PFDI-20评分)、盆底障碍影响简易问卷-7(PFIQ-7评分)、盆腔器官脱垂/尿失禁性生活质量问卷-12(PISQ-12评分)以及术后复发率及手术并发症情况,共随访2年。结果术前与术后的POP-Q评分比较,客观治愈率100%,差异有统计学意义(P <0.05)。手术后POP-Q中的各位点值均上升,达到解剖学复位。术后的PFDI-20及PFIQ-7评分低于术前,差异有统计学意义(P <0.05)。术后PISQ-12评分高于术前,差异有统计学意义(P <0.05)。术后脱垂复发率为4.42%,疼痛发生率为8.81%,网片暴露率为4.85%,主观满意率为96.5%。结论经阴盆底重建术治疗II-IV度POP安全、疗效确切,对患者生活质量有明显地提高和改善,是POP的理想术式。
【Objective】To investigate the clinical effect of pelvic floor reconstruction surgery in the treatment of patients with severe pelvic organ prolapse(POP).【Methods】Totally 227 severe pelvic organ prolapse patients who underwent pelvic floor reconstruction surgery with transvaginal mesh was analyzed at Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital from January 2012 to December 2015. Pelvic Organ Prolapse Quantification(POP-Q) scores, Pelvic Floor Distress Inventory-Short Form 20(PFDI-20) scores, Pelvic Floor Impact QuestionnaireShort Form 7(PFIQ-7) scores, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-Short Form 12(PISQ-12) scores, postoperation recurrence rate, postoperation painness rate, the mesh exposure rate and complications were analyzed. The follow-up time was 2 years.【Results】The postoperative POP-Q scores were statistically improved compared with preoperative(P <0.05). The objective cure rate was 100%. The postoperative PFDI-20 and PFIQ-7 scores were lower, the difference was statistically significant(P <0.05). After operation, PISQ-12 scores were significantly higher than those before operation(P <0.05). The recurrence rate, the painness rate and the mesh exposure rate was 4.42%, 8.81%, 4.85%, respectively. The subjective cure rate was 96.5%.【Conclusion】Pelvic floor reconstruction surgery is a safe and effective surgery for pelvic organ prolapse patients, significantly improving the quality of life of patients. It is an ideal surgery for pelvic organ prolapse.
【Objective】To investigate the clinical effect of pelvic floor reconstruction surgery in the treatment of patients with severe pelvic organ prolapse(POP).【Methods】Totally 227 severe pelvic organ prolapse patients who underwent pelvic floor reconstruction surgery with transvaginal mesh was analyzed at Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital from January 2012 to December 2015. Pelvic Organ Prolapse Quantification(POP-Q) scores, Pelvic Floor Distress Inventory-Short Form 20(PFDI-20) scores, Pelvic Floor Impact QuestionnaireShort Form 7(PFIQ-7) scores, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-Short Form 12(PISQ-12) scores, postoperation recurrence rate, postoperation painness rate, the mesh exposure rate and complications were analyzed. The follow-up time was 2 years.【Results】The postoperative POP-Q scores were statistically improved compared with preoperative(P <0.05). The objective cure rate was 100%. The postoperative PFDI-20 and PFIQ-7 scores were lower, the difference was statistically significant(P <0.05). After operation, PISQ-12 scores were significantly higher than those before operation(P <0.05). The recurrence rate, the painness rate and the mesh exposure rate was 4.42%, 8.81%, 4.85%, respectively. The subjective cure rate was 96.5%.【Conclusion】Pelvic floor reconstruction surgery is a safe and effective surgery for pelvic organ prolapse patients, significantly improving the quality of life of patients. It is an ideal surgery for pelvic organ prolapse.
引文
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[5]Khan ZA,Thomas L,Emery SJ,et al.Outcomes and complications of trans-vaginal mesh repair using the ProliftTMkit for pelvic organ prolapse at 4 years median follow-up in a tertiary referral centre[J].Arch Gynecol Obstet,2014,290(6):1151-1157.
[6]Zhang L,Zhu L,Xu T,et al.Postoperative voiding difficulty and mesh-related complications after Total Prolift System surgical repair for pelvic organ prolapse and predisposing factors[J].Menopause,2015,22(8):885-892.
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[8]吴志芬,宋岩峰,黄慧娟,等.盆底重建手术治疗盆腔脏器脱垂的临床研究[J].中国妇产科临床杂志,2012,13(2):85-87.
[9]陈承美.女性盆底功能障碍性疾病的研究进展[J].中国处方药,2015,13(12):143-144.
[10]Meyer I,McGwin G,Swain TA,et al.Synthetic graft augmentation in vaginal prolapse surgery:long-term objective and subjective outcomes[J].J Minim Invasive Gynecol,2016,23(4):614-621.
[11]Maher C,Feiner B,Baessler K,et al.Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse[J].Cochrane Database of Systematic Reviews,2016,2(2):CD012079.
[12]Jacquetin B,Hinoul P,Gauld J,et al.Total transvaginal mesh(TVM)technique for treatment of pelvic organ prolapse:a 5-year prospective follow-up study[J].Int Urogynecol J,2013,24(10):1679-1686.
[13]杨欣,王建六.盆底重建手术网片相关并发症的预防与处理[J].中国妇产科临床杂志,2017,18(2):102-104.
[14]Balchandra P,Marsh F,Landon C.Perioperative outcomes and prospective patient reported outcome measures for transvaginal mesh surgery[J].Arch Gynecol Obstet,2015,292(4):875-882.
[15]孙秀丽,王晓迪,牟田,等.Prolift系统盆底重建术的临床疗效及对患者生活质量的影响[J].中国妇产科临床杂志,2012,13(2):88-91.
[2]王建六.要与时俱进地评价盆底重建手术[J].中国妇产科临床杂志,2012,13(2):81-82.
[3]王佳,鲁永鲜.经阴道网片盆底重建手术的历史及应用现状与争论[J].中华妇产科杂志,2013,48(7):554-556.
[4]Bai SW,Yoon BS,Kwon JY,et al.Survey of the characteristics and satisfaction degree of the patients using apessary[J].Int Urogynecol J Pelvic Floor Dysfunct,2005,16(3):182-186.
[5]Khan ZA,Thomas L,Emery SJ,et al.Outcomes and complications of trans-vaginal mesh repair using the ProliftTMkit for pelvic organ prolapse at 4 years median follow-up in a tertiary referral centre[J].Arch Gynecol Obstet,2014,290(6):1151-1157.
[6]Zhang L,Zhu L,Xu T,et al.Postoperative voiding difficulty and mesh-related complications after Total Prolift System surgical repair for pelvic organ prolapse and predisposing factors[J].Menopause,2015,22(8):885-892.
[7]Laso-Garcia IM,Rodriquez-Cabello MA,Jiménez-Cidre MA,et al.Prospective long-term results,complications and risk factors in pelvic organ prolapse treatment with vaginal mesh[J].Eur JObstet Gynecol Reprod Biol,2017,211(1):62-67.
[8]吴志芬,宋岩峰,黄慧娟,等.盆底重建手术治疗盆腔脏器脱垂的临床研究[J].中国妇产科临床杂志,2012,13(2):85-87.
[9]陈承美.女性盆底功能障碍性疾病的研究进展[J].中国处方药,2015,13(12):143-144.
[10]Meyer I,McGwin G,Swain TA,et al.Synthetic graft augmentation in vaginal prolapse surgery:long-term objective and subjective outcomes[J].J Minim Invasive Gynecol,2016,23(4):614-621.
[11]Maher C,Feiner B,Baessler K,et al.Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse[J].Cochrane Database of Systematic Reviews,2016,2(2):CD012079.
[12]Jacquetin B,Hinoul P,Gauld J,et al.Total transvaginal mesh(TVM)technique for treatment of pelvic organ prolapse:a 5-year prospective follow-up study[J].Int Urogynecol J,2013,24(10):1679-1686.
[13]杨欣,王建六.盆底重建手术网片相关并发症的预防与处理[J].中国妇产科临床杂志,2017,18(2):102-104.
[14]Balchandra P,Marsh F,Landon C.Perioperative outcomes and prospective patient reported outcome measures for transvaginal mesh surgery[J].Arch Gynecol Obstet,2015,292(4):875-882.
[15]孙秀丽,王晓迪,牟田,等.Prolift系统盆底重建术的临床疗效及对患者生活质量的影响[J].中国妇产科临床杂志,2012,13(2):88-91.
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