应用六翼成型网片的二代全盆底重建术治疗女性重度盆腔器官脱垂术后主客观效果评估
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摘要
目的探讨应用六翼成型网片行全盆底重建术在盆腔器官脱垂治疗中的效果。方法对中国医科大学附属盛京医院妇科病房2016年10月至2017年12月间以前、中盆腔器官脱垂为主的手术病例,按手术术式不同分组,观察组78例应用六翼成型网片的全盆底重建术;对照组82例应用不可吸收聚丙烯网片进行前后路的全盆底重建手术,所有患者均于术后3、6、12个月门诊复查,应用客观及主观评价对两组患者术后恢复情况进行比较。结果 (1)客观评价:术后12个月内两组患者均未见复发,POP评分法测定各指示点均恢复正常位置,术后12个月观察组患者阴道长度长于对照组,差异有统计学意义(P<0.05)。(2)主观症状评分,术后6、12个月盆底功能障碍量表(PFDI-20)评分,观察组22.66±5.34、16.23±5.12,对照组30.87±5.32、21.86±5.28,观察组均低于对照组,差异均有统计学意义(P<0.05)。其中直肠肛门障碍量表(CRADI-8)评分,术后6、12个月观察组评分均低于对照组,差异均有统计学意义(P<0.05)。观察组术后6、12个月女性性功能量表(FSFI)均优于对照组,差异有统计学意义(P<0.05)。(3)术后并发症:在网片暴露和性交痛发生率方面,观察组均低于对照组,差异有统计学意义(P<0.05)。结论六翼成型网片的全盆底重建术与传统的盆底重建手术有着同样的治愈率,而在主观症状改善以及减少术后并发症方面更优于传统的盆底重建手术。
Objective To investigate the effect of total pelvic floor reconstruction with 6-arm mesh in the treatment of pelvic organ prolapse.Methods The patients who received different surgical procedures for the anterior and middle pelvic organ prolapse between October 2016 and December 2017 in Gynecological Department of Shengjing Hospital of China Medical University,were divided into two groups.There were 78 cases in observation group who used six-arm mesh,and 82 patients in control group who underwent total pelvic floor reconstruction with anterior and posterior unabsorbable polypropylene mesh. All patients were reviewed at 3,6,and 12 months after surgery.Objective and subjective evaluations were used to compare the postoperative recovery between the two groups.Results(1)Objective evaluation:there was no recurrence in the two groups within 12 months after the operation;the POP-Q score showed that all indication points returned to normal position;the length of vagina at the 12 th month after the operation was longer than that of the control group;the difference was statistically significant(P<0.05).(2)Subjective symptom score:PFDI-20 score at 6 months and 12 months after surgery in observation group was 22.66±5.34 and 16.23±5.12,while in control group it was 30.87±5.32 and 21.86±5.28,observation group lower than control group,the difference being statistically significant(P<0.05).Among them,the CRADI-8 score was lower than that of the control group in 6 months and 12 months after surgery,and the differences were statistically significant(P<0.05).Compared with FSFI,the observation group was superior to the control group in 6 months and 12 months after operation,and the difference was statistically significant(P<0.05).(3)Postoperative complications: the observation group was lower than the control group in terms of the incidence of mesh exposure and sex pain,the difference being statistically significant(P<0.05).Conclusion The total pelvic floor reconstruction with six-arm mesh has the same healing rate as traditional pelvic floor reconstruction surgery,and it is better than traditional pelvic floor reconstruction surgery in improving subjective symptoms and reducing postoperative complications.
Objective To investigate the effect of total pelvic floor reconstruction with 6-arm mesh in the treatment of pelvic organ prolapse.Methods The patients who received different surgical procedures for the anterior and middle pelvic organ prolapse between October 2016 and December 2017 in Gynecological Department of Shengjing Hospital of China Medical University,were divided into two groups.There were 78 cases in observation group who used six-arm mesh,and 82 patients in control group who underwent total pelvic floor reconstruction with anterior and posterior unabsorbable polypropylene mesh. All patients were reviewed at 3,6,and 12 months after surgery.Objective and subjective evaluations were used to compare the postoperative recovery between the two groups.Results(1)Objective evaluation:there was no recurrence in the two groups within 12 months after the operation;the POP-Q score showed that all indication points returned to normal position;the length of vagina at the 12 th month after the operation was longer than that of the control group;the difference was statistically significant(P<0.05).(2)Subjective symptom score:PFDI-20 score at 6 months and 12 months after surgery in observation group was 22.66±5.34 and 16.23±5.12,while in control group it was 30.87±5.32 and 21.86±5.28,observation group lower than control group,the difference being statistically significant(P<0.05).Among them,the CRADI-8 score was lower than that of the control group in 6 months and 12 months after surgery,and the differences were statistically significant(P<0.05).Compared with FSFI,the observation group was superior to the control group in 6 months and 12 months after operation,and the difference was statistically significant(P<0.05).(3)Postoperative complications: the observation group was lower than the control group in terms of the incidence of mesh exposure and sex pain,the difference being statistically significant(P<0.05).Conclusion The total pelvic floor reconstruction with six-arm mesh has the same healing rate as traditional pelvic floor reconstruction surgery,and it is better than traditional pelvic floor reconstruction surgery in improving subjective symptoms and reducing postoperative complications.
引文
[1]刘丹,夏志军.美国妇产科医师学会“盆腔器官脱垂临床实践指南(2017版)”解读[J].中国实用妇科与产科杂志,2018,34(10):1111-1114.
[2]朱兰.经阴道植入合成网片盆底重建术的现状和争议[J].中国实用妇科与产科杂志,2019,35(1):15-16.
[3]尹一童,夏志军.全盆底重建术并发症预防及处理[J].中国实用妇科与产科杂志,2015,31(4):292-295.
[4]朱兰.盆腔器官脱垂手术治疗临床评估应注意的问题[J].中国实用妇科与产科杂志,2017,33(10):993-994.
[5]Zhang L,Zhu L,Chen J,et al.Tension-free polypropylene mesh-related surgical repair for pelvic organ prolapse has a good anatomic success rate but a high risk of complications[J].Chinese Med J,2015,128(3):195-300.
[6]Khan ZA,Thomas L,Emery SJ.Outcomes and complications of trans-vaginal mesh repair using the Prolift kit for pelvic organ prolapse at 4 years median follow-up in a tertiary referral centre[J].Arch Gynecol Obstet,2014,290(6):1151-1157.
[7]Laso-Garcia IM,Rodriquez-Cabello MA,Jimenez-Cidre MA,et al.Prospective long-term results,complications and risk factors in pelvic organ prolapse treatment with vaginal mesh[J].Eur J Obstet Gynecol Reprod Biol,2017,211(1):62-67.
[8]Isuzu M,Gerald MG,Thomas AS,et al.Synthetic graft augmentation in vaginal prolapse surgery:long-term objective and subjective outcomes[J].Minim Invasive Gynecol,2016,23(4):614-621.
[9]Enrique P,Ubertazzi A,Hector FE,et al.Long-term outcomes of transvaginal mesh(TVM)in patients with pelvic organ prolapse:a 5-year follow-up[J].Eur J Obstet Gynecol Reprod Biol,2018,225:90-94.
[10]Wan OY,Chan SS,Cheung RY,et al.Mesh-related complications from reconstructive surgery for pelvic organ prolapse in Chinese patients in Hong Kong[J].Hong Kong Med,2018,24(4):369-377.
[11]Elizabeth J,Emma B,Andrea G,et al.Incidence and risk factors for pelvic pain after mesh implant surgery for the treatment of pelvic floor disorders[J].J Minim Invasive Gynecol,2017,24(1):67-73.2019-03-102019-04-29
[2]朱兰.经阴道植入合成网片盆底重建术的现状和争议[J].中国实用妇科与产科杂志,2019,35(1):15-16.
[3]尹一童,夏志军.全盆底重建术并发症预防及处理[J].中国实用妇科与产科杂志,2015,31(4):292-295.
[4]朱兰.盆腔器官脱垂手术治疗临床评估应注意的问题[J].中国实用妇科与产科杂志,2017,33(10):993-994.
[5]Zhang L,Zhu L,Chen J,et al.Tension-free polypropylene mesh-related surgical repair for pelvic organ prolapse has a good anatomic success rate but a high risk of complications[J].Chinese Med J,2015,128(3):195-300.
[6]Khan ZA,Thomas L,Emery SJ.Outcomes and complications of trans-vaginal mesh repair using the Prolift kit for pelvic organ prolapse at 4 years median follow-up in a tertiary referral centre[J].Arch Gynecol Obstet,2014,290(6):1151-1157.
[7]Laso-Garcia IM,Rodriquez-Cabello MA,Jimenez-Cidre MA,et al.Prospective long-term results,complications and risk factors in pelvic organ prolapse treatment with vaginal mesh[J].Eur J Obstet Gynecol Reprod Biol,2017,211(1):62-67.
[8]Isuzu M,Gerald MG,Thomas AS,et al.Synthetic graft augmentation in vaginal prolapse surgery:long-term objective and subjective outcomes[J].Minim Invasive Gynecol,2016,23(4):614-621.
[9]Enrique P,Ubertazzi A,Hector FE,et al.Long-term outcomes of transvaginal mesh(TVM)in patients with pelvic organ prolapse:a 5-year follow-up[J].Eur J Obstet Gynecol Reprod Biol,2018,225:90-94.
[10]Wan OY,Chan SS,Cheung RY,et al.Mesh-related complications from reconstructive surgery for pelvic organ prolapse in Chinese patients in Hong Kong[J].Hong Kong Med,2018,24(4):369-377.
[11]Elizabeth J,Emma B,Andrea G,et al.Incidence and risk factors for pelvic pain after mesh implant surgery for the treatment of pelvic floor disorders[J].J Minim Invasive Gynecol,2017,24(1):67-73.2019-03-102019-04-29
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