改进盆底重建术联合TVT-O在盆腔器官脱垂伴下尿路症状患者中的应用
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摘要
目的观察盆腔器官脱垂(POP)伴下尿路症状患者经改进盆底重建手术(PRS)后的排尿情况及下尿路症状变化,探讨术中联合应用经闭孔尿道中段无张力悬吊带术(TVT-O)对下尿路症状的影响及其临床价值。方法回顾性分析襄阳市妇幼保健院妇产科于2014年1月至2017年2月收治的112例行盆腔器官脱垂手术患者的临床资料。根据患者术式不同分为对照组38例、观察Ⅰ组36例和观察Ⅱ组38例。对照组采用单纯改进盆底重建手术,观察Ⅰ组和观察Ⅱ组在对照组的基础上分别行TVT-O、TVT-O网片吊带置入术。比较3组患者的一般情况、围术期相关指标和手术前后的下尿路症状发生率;用盆腔器官脱垂定量检查法(POP-Q)评估患者术前和术后6个月的盆底器官脱垂程度;采用PFDI-20盆底功能障碍调查问卷随访患者手术前、术后6个月排尿情况和主观POP症状,评价这3种术式对患者下尿路症状的影响。结果 3组患者术后24 h最高体温、肛门排气时间、尿管留置时间及术后住院时间等指标差异无统计学意义(P>0. 05); 3组患者的下尿路症状在术后6个月的发生率较术前明显降低(P <0. 05);术后6个月观察Ⅰ组、观察Ⅱ组患者下尿路症状发生率均低于对照组(P <0. 05);观察Ⅰ组、观察Ⅱ组患者手术时间及术中出血量均明显多于对照组,但术后残余尿量少于对照组(P <0. 05)。术后6个月,观察Ⅰ组、观察Ⅱ组患者的C点距离、D点距离、阴道总长度均显著大于对照组(P <0. 05);术后6个月下尿路症状改善率:对照组71. 1%、观察Ⅰ组83. 3%、观察Ⅱ组92. 1%,观察Ⅱ组优于观察Ⅰ组,对照组最低,组间差异均有统计学意义(P <0. 05)。结论改进盆底重建手术对盆腔器官脱垂伴下尿路症状患者有较好的疗效,在术中加行TVT-O技术治疗能有效改善患者的下尿路症状。
Objective To observe the changes of urination and lower urinary tract symptoms after improved pelvic floor reconstruction( PRS) in patients with pelvic organ prolapse( POP) and lower urinary tract symptoms,and to explore the effect of PRS combined with TVTO on lower urinary tract symptoms and its clinical value. Methods A retrospective study was performed on 112 patients treated with pelvic organ prolapse surgery from January 2014 to February 2017 in Xiangyang maternal and child health hospital. The patients were divided into three groups according to the patient's procedure,of whom 36 patients in observation group Ⅰ,38 patients in observation group Ⅱ and 38 patients in the control group. The control group was treated with modified pelvic floor reconstruction,the observation group Ⅰ and the observation group Ⅱwere treated with TVT-O and TVT-O mesh sling placement on the basis of the control group respectively. The general conditions and perioperative indicators of the three groups were compared; the incidence of lower urinary tract symptoms before and after surgery was compared in the three groups; the pelvic organ prolapse quantitative test( POP-Q) was used to evaluate preoperative and postoperative halfyearly degree of prolapse of the base organ. The PFDI-20 pelvic floor dysfunction questionnaire was followed up for the patient's urinary and subjective POP symptoms before and after surgery,and the effects of these three procedures on the lower urinary tract disease were evaluated.Results There was no significant difference in highest body temperature within 24 hours after surgery,anal discharge time,duration of catheterization and length of hospitalization( P > 0. 05). The incidence of lower urinary tract symptoms of the three groups at 6 months after surgery was significantly lower than that before surgery( P < 0. 05); the incidence of lower urinary tract symptoms was lower in group Ⅰ and group Ⅱthan in the control group( P < 0. 05). The operative time,intraoperative blood loss of observation group Ⅰ and observation group Ⅱ were significantly higher than those of the control group,but the postoperative residual urine was less than that of the control group( P < 0. 05). After6 months,the distance of point C,point D and length of the vagina of observation group Ⅰ and groupⅡ were significantly longer than those of the control group( P < 0. 05),and three cases of lower urinary tract symptoms after pelvic floor reconstruction surgery,TVT-O surgery,and TVT mesh surgery were improved after six months. The improvement rates of lower urinary tract symptoms in control group,observation groupⅠ and observation group Ⅱ were 71. 1%,83. 3%,and 92. 1%,respectively. Observation group Ⅱ was superior to observation group Ⅰ,and the lowest was the control group,the differences were significant( P < 0. 05). Conclusion Improved pelvic floor reconstruction has good curative effect on patients with pelvic organ prolapse and lower urinary tract symptoms,combined with TVT-O technology can effectively improve the patient's lower urinary tract symptoms.
Objective To observe the changes of urination and lower urinary tract symptoms after improved pelvic floor reconstruction( PRS) in patients with pelvic organ prolapse( POP) and lower urinary tract symptoms,and to explore the effect of PRS combined with TVTO on lower urinary tract symptoms and its clinical value. Methods A retrospective study was performed on 112 patients treated with pelvic organ prolapse surgery from January 2014 to February 2017 in Xiangyang maternal and child health hospital. The patients were divided into three groups according to the patient's procedure,of whom 36 patients in observation group Ⅰ,38 patients in observation group Ⅱ and 38 patients in the control group. The control group was treated with modified pelvic floor reconstruction,the observation group Ⅰ and the observation group Ⅱwere treated with TVT-O and TVT-O mesh sling placement on the basis of the control group respectively. The general conditions and perioperative indicators of the three groups were compared; the incidence of lower urinary tract symptoms before and after surgery was compared in the three groups; the pelvic organ prolapse quantitative test( POP-Q) was used to evaluate preoperative and postoperative halfyearly degree of prolapse of the base organ. The PFDI-20 pelvic floor dysfunction questionnaire was followed up for the patient's urinary and subjective POP symptoms before and after surgery,and the effects of these three procedures on the lower urinary tract disease were evaluated.Results There was no significant difference in highest body temperature within 24 hours after surgery,anal discharge time,duration of catheterization and length of hospitalization( P > 0. 05). The incidence of lower urinary tract symptoms of the three groups at 6 months after surgery was significantly lower than that before surgery( P < 0. 05); the incidence of lower urinary tract symptoms was lower in group Ⅰ and group Ⅱthan in the control group( P < 0. 05). The operative time,intraoperative blood loss of observation group Ⅰ and observation group Ⅱ were significantly higher than those of the control group,but the postoperative residual urine was less than that of the control group( P < 0. 05). After6 months,the distance of point C,point D and length of the vagina of observation group Ⅰ and groupⅡ were significantly longer than those of the control group( P < 0. 05),and three cases of lower urinary tract symptoms after pelvic floor reconstruction surgery,TVT-O surgery,and TVT mesh surgery were improved after six months. The improvement rates of lower urinary tract symptoms in control group,observation groupⅠ and observation group Ⅱ were 71. 1%,83. 3%,and 92. 1%,respectively. Observation group Ⅱ was superior to observation group Ⅰ,and the lowest was the control group,the differences were significant( P < 0. 05). Conclusion Improved pelvic floor reconstruction has good curative effect on patients with pelvic organ prolapse and lower urinary tract symptoms,combined with TVT-O technology can effectively improve the patient's lower urinary tract symptoms.
引文
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[5]赵颖,刘丹,夏志军.盆腔器官脱垂术前全面评估和术式选择[J].中国实用妇科与产科杂志,2017,33(10):1034-1038. doi:10.3969/j. issn. 1671-7171. 2018. 01. 051.
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[9]崔小娟,范湘玲,李华.盆底功能障碍患者绝经后的盆底肌力状况和生活质量分析[J].医学临床研究,2018,35(3):587-589. doi:10. 3969/j. issn. 1671-7171. 2018. 01. 051.
[10]元万芹,王国荣,李萍,等.倍美力软膏配合复方甲硝唑栓对老年性阴道炎患者血清性激素及微量元素的影响[J].中国妇幼保健,2018,33(5):1045-1048. doi:10. 3969/j. issn. 1671-7171.2018. 01. 051.
[11]苏桂芳,白雪.盆腔重建Prolift手术运用于老年女性重度盆腔器官脱垂治疗的效果观察[J].重庆医学,2017,46(A03):301-302.
[12]杨晓辉,赵志英. Prolift网片与聚丙烯网片在全盆底重建治疗中的对比[J].中国组织工程研究,2016,20(34):5122-5128. doi:10.3969/j. issn. 2095-4344. 2016. 34. 017.
[13]廖莎,周俊英,罗万英.改良医用T型盆腔引流管的设计与应用[J].护理管理杂志,2016,16(2):125.
[14]陈燕,居文惠. TVT-O技术在盆腔器官脱垂患者行盆底功能修复中对下尿路症状、POP-Q分度的改善作用分析[J].广西医科大学学报,2018,35(1):37-40. doi:10. 16190/j. cnki. 45-1211/r.2018. 01. 010.
[15]Leshem A,Groutz A,Amir H,et al. Surgically induced weight loss results in a rapid and consistent improvement of female pelvic floor symptoms[J]. Scand J Urol,2018,52(3):219-224. doi:10. 1080/21681805. 2018. 1447600.
[16]丁景新,陈建亮,张宏伟,等.宫腹腔镜联合修补剖宫产术后子宫切口憩室[J].世界最新医学信息文摘,2017,39(16):506-510.doi:10. 3969/j. issn. 1671-7171. 2018. 01. 051.
[17]韩加刚,王振军,魏广辉,等.生物补片在低位进展期直肠癌肛提肌外腹会阴联合切除术盆底重建中的应用价值[J].中华消化外科杂志,2018,17(2):161-167. doi:10. 3969/j. issn. 1671-7171.2018. 01. 051.
[18]陈延,刘洪久,肖永强,等.经尿道膀胱颈内切开术治疗女性膀胱颈梗阻的疗效观察[J].临床泌尿外科杂志,2018,33(2):160-162. doi:10. 13201/j. issn. 1001-1420. 2018. 02. 020.
[19]王洋.经阴道子宫切除联合阴道前后壁修补术对盆腔器官脱垂患者生活质量及盆底功能的影响[J].医学临床研究,2018,35(1):150-152. doi:10. 3969/j. issn. 1671-7171. 2018. 01. 051.
[20]方露雪,曹莉莉,赵娜,等.盆腔器官脱垂患者盆底重建手术后新发压力性尿失禁相关影响因素分析[J].局解手术学杂志,2017,26(4):290-294. doi:10. 3969/j. issn. 1671-7171. 2018. 01.051.
[21]马艳群,吴伟英.女性轻度盆腔器官脱垂的非手术治疗进展[J].中国保健营养,2017,27(30):449-450. doi:10. 3969/j. issn.1004-7484. 2017. 30. 725.
[22]Takazawa N,Fujisaki A,Yoshimura Y,et al. Short-term outcomes of the transvaginal minimal mesh procedure for pelvic organ prolapse[J].Invest Clin Urol,2018,59(2):133-140. doi:10. 4111/icu. 2018.59. 2. 133.
[23]曹韵清,黄伟俊,温影红,等.经会阴四维超声对女性行经耻骨后路径阴道无张力尿道中段悬吊术后的观察及疗效评估[J].广东医学,2018,39(4):566-568. doi:10. 3969/j. issn. 1001-9448.2018. 04. 020.
[2]Marschke J,Pax CM,Beilecke K,et al. Vaginal hysterectomy with apical fixation and anterior vaginal wall repair for prolapse:surgical technique and medium-term results[J]. Int Urogynecol J,2018,29(8):1187-1192. doi:10. 1007/s00192-018-3600-z.
[3]兰健.女性盆腔器官脱垂的危险因素分析[J].中国社区医师,2017,33(7):64-65. doi:10. 3969/j. issn. 1671-7171. 2018. 01.051.
[4]陈燕,居文惠. TVT-O技术在盆腔器官脱垂患者行盆底功能修复中对下尿路症状、POP-Q分度的改善作用分析[J].广西医科大学学报,2018,35(1):37-40. doi:10. 16190/j. cnki. 45-1211/r.2018. 01. 010.
[5]赵颖,刘丹,夏志军.盆腔器官脱垂术前全面评估和术式选择[J].中国实用妇科与产科杂志,2017,33(10):1034-1038. doi:10.3969/j. issn. 1671-7171. 2018. 01. 051.
[6]Helmuth ME,Smith AR,Andreev VP,et al. Use of Euclidean length to measure urinary incontinence severity based on the lower urinary tract symptoms tool[J]. Am J Obstet Gynecol,2018,218(3):357-359.doi:10. 1016/j. ajog. 2017. 12. 219.
[7]杨琳,张金玲,张立杰,等. Prolif盆底重建术治疗重度盆腔器官脱垂患者预后影响因素分析[J].中国计划生育和妇产科,2017,9(2):46-50. doi:10. 3969/j. issn. 1671-7171. 2018. 01. 051.
[8]章君华,应瑜,施灵美,等.前盆腔网片重建术联合骶棘韧带固定术治疗盆腔器官脱垂42例分析[J].浙江医学,2018,40(4):383-385. doi:10. 3969/j. issn. 1671-7171. 2018. 01. 051.
[9]崔小娟,范湘玲,李华.盆底功能障碍患者绝经后的盆底肌力状况和生活质量分析[J].医学临床研究,2018,35(3):587-589. doi:10. 3969/j. issn. 1671-7171. 2018. 01. 051.
[10]元万芹,王国荣,李萍,等.倍美力软膏配合复方甲硝唑栓对老年性阴道炎患者血清性激素及微量元素的影响[J].中国妇幼保健,2018,33(5):1045-1048. doi:10. 3969/j. issn. 1671-7171.2018. 01. 051.
[11]苏桂芳,白雪.盆腔重建Prolift手术运用于老年女性重度盆腔器官脱垂治疗的效果观察[J].重庆医学,2017,46(A03):301-302.
[12]杨晓辉,赵志英. Prolift网片与聚丙烯网片在全盆底重建治疗中的对比[J].中国组织工程研究,2016,20(34):5122-5128. doi:10.3969/j. issn. 2095-4344. 2016. 34. 017.
[13]廖莎,周俊英,罗万英.改良医用T型盆腔引流管的设计与应用[J].护理管理杂志,2016,16(2):125.
[14]陈燕,居文惠. TVT-O技术在盆腔器官脱垂患者行盆底功能修复中对下尿路症状、POP-Q分度的改善作用分析[J].广西医科大学学报,2018,35(1):37-40. doi:10. 16190/j. cnki. 45-1211/r.2018. 01. 010.
[15]Leshem A,Groutz A,Amir H,et al. Surgically induced weight loss results in a rapid and consistent improvement of female pelvic floor symptoms[J]. Scand J Urol,2018,52(3):219-224. doi:10. 1080/21681805. 2018. 1447600.
[16]丁景新,陈建亮,张宏伟,等.宫腹腔镜联合修补剖宫产术后子宫切口憩室[J].世界最新医学信息文摘,2017,39(16):506-510.doi:10. 3969/j. issn. 1671-7171. 2018. 01. 051.
[17]韩加刚,王振军,魏广辉,等.生物补片在低位进展期直肠癌肛提肌外腹会阴联合切除术盆底重建中的应用价值[J].中华消化外科杂志,2018,17(2):161-167. doi:10. 3969/j. issn. 1671-7171.2018. 01. 051.
[18]陈延,刘洪久,肖永强,等.经尿道膀胱颈内切开术治疗女性膀胱颈梗阻的疗效观察[J].临床泌尿外科杂志,2018,33(2):160-162. doi:10. 13201/j. issn. 1001-1420. 2018. 02. 020.
[19]王洋.经阴道子宫切除联合阴道前后壁修补术对盆腔器官脱垂患者生活质量及盆底功能的影响[J].医学临床研究,2018,35(1):150-152. doi:10. 3969/j. issn. 1671-7171. 2018. 01. 051.
[20]方露雪,曹莉莉,赵娜,等.盆腔器官脱垂患者盆底重建手术后新发压力性尿失禁相关影响因素分析[J].局解手术学杂志,2017,26(4):290-294. doi:10. 3969/j. issn. 1671-7171. 2018. 01.051.
[21]马艳群,吴伟英.女性轻度盆腔器官脱垂的非手术治疗进展[J].中国保健营养,2017,27(30):449-450. doi:10. 3969/j. issn.1004-7484. 2017. 30. 725.
[22]Takazawa N,Fujisaki A,Yoshimura Y,et al. Short-term outcomes of the transvaginal minimal mesh procedure for pelvic organ prolapse[J].Invest Clin Urol,2018,59(2):133-140. doi:10. 4111/icu. 2018.59. 2. 133.
[23]曹韵清,黄伟俊,温影红,等.经会阴四维超声对女性行经耻骨后路径阴道无张力尿道中段悬吊术后的观察及疗效评估[J].广东医学,2018,39(4):566-568. doi:10. 3969/j. issn. 1001-9448.2018. 04. 020.