经阴道网片盆底重建术的疗效中长期随访

doi:10.6040/j.issn.1671-7554.0.2021.1244

摘要/Abstract

摘要： 目的探讨盆腔脏器脱垂的经阴道网片盆底重建术是否保留子宫的疗效分析以及术后的中长期影响。方法选择2010年1月至2016年12月期间因盆腔脏器脱垂而手术治疗的患者76例为研究对象。根据手术方式匹配分为保留子宫组(UC)和切除子宫组(CH)两组,各38例。比较两组围手术期指标及盆腔器官脱垂定量分期法(POP-Q)术前、术后6个月、术后1年、术后5年分度评价客观疗效。采用盆底障碍量表简表(PFDI-20)、盆底障碍影响简易问卷(PFIQ-7)及盆腔器官脱垂/尿失禁性生活质量问卷(PISQ-12)评分判定主观疗效。结果 UC与CH组比较,围手术期指标中住院天数(P<0.001)、术中出血(P<0.001)、手术时间(P<0.001)、术后排气时间(P=0.004)、留置尿管时间(P<0.001)均优于CH组。POP-Q分度:两组术后较术前均有所改善。PFDI-20、PFIQ-7、PISQ-12评分,UC、CH组各自不同时间(术前、术后6个月、术后1年、术后5年)比较,差异均有统计学意义(P<0.001),均有所改善;UC与CH组比较PISQ-12评分术后6个月(P<0.001)、术后1年(P<0.001)、术后5年(P<0.001)均优于CH组;中长期随访中,经阴道网片盆底重建术术后共3例盆腔感染、6例排尿困难,其余正常。结论经阴道网片盆底重建术中网片的使用安全有效,是否保留子宫不影响术后疗效,但保留子宫可改善围手术期指标、提高患者性生活质量。

关键词: 盆底重建术, 盆底网片, 盆腔脏器脱垂, 疗效分析

Abstract: Objective To analyze the medium- and long-term efficacy of transvaginal mesh pelvic floor reconstruction with or without uterus preservation. Methods A total of 76 patients with pelvic floor organ prolapse who underwent surgical treatment during Jan. 2010 and Dec. 2016 were selected as the research objects and divided into two groups: uterus conservation(UC)group and concomitant hysterectomy(CH)group, with 38 cases in either group. The perioperative indicators and changes of POP-Q scores before operation, 6 months, 1 year and 5 years after operation as the objective curative effect were compared. The Pelvic Floor Disorder Scale(PFDI-20), Pelvic Floor Disorder Impact Simple Questionnaire(PFIQ-7)and Pelvic Organ Prolapse/Urinary Incontinence Quality of Life Questionnaire(PISQ-12)scores as the subjective curative effect were compared. Results The UC group had shorter length of hospital stay(P<0.001), operation time(P<0.001), postoperative exhaust time(P=0.004), urinary catheter indwelling time(P<0.001)and less intraoperative bleeding volume(P<0.001)than the CH group. The POP-Q scores in both groups were improved after operation. There were significant differences in PFDI-20, PFIQ-7 and PISQ-12 scores at different times(P<0.001). The UC group had higher PISQ-12 score at 6 months(P<0.001), 1 year(P<0.001)and 5 years(P<0.001)after the operation than the CH group. During the medium- and long-term follow-up, there were 3 cases of pelvic infection and 6 cases of dysuria, and no other complications were observed. Conclusion Transvaginal mesh pelvic floor reconstruction is safe and effective. Whether to preserve the uterus does not affect the postoperative efficacy, but preserving the uterus can improve perioperative indicators and quality of sexual life.

Key words: Transvaginal mesh pelvic floor reconstruction, Pelvic floor mesh, Pelvic organ prolapse, Curative effect

中图分类号:

R713.4

李青,林雪艳,刘天航,李晓文,范明喆,赵瑞瑞,田永杰. 经阴道网片盆底重建术的疗效中长期随访[J]. 山东大学学报 (医学版), 2022, 60(3): 71-75.

LI Qing, LIN Xueyan, LIU Tianhang, LI Xiaowen, FAN Mingzhe, ZHAO Ruirui, TIAN Yongjie. Medium- and long-term efficacy of transvaginal mesh pelvic floor reconstruction[J]. Journal of Shandong University (Health Sciences), 2022, 60(3): 71-75.

参考文献

[1] Tegerstedt G, Maehle-Schmidt M, Nyren O, et al. Prevalence of symptomatic pelvic organ prolapse in a Swedish population [J]. Int Urogynecol J Pelvic Floor Dysfunct, 2005, 16(6): 497-503.
[2] Lucot JP, Cosson M, Bader G, et al. Safety of vaginal mesh surgery versus laparoscopic mesh sacropexy for cystocele repair: results of the prosthetic pelvic floor repair randomized controlled trial [J]. Eur Urol, 2018, 74(2): 167-176.
[3] Al KM, Al BZ, Jaju S, et al. Urinary incontinence among omani women: prevalence, risk factors and impact on quality of life [J]. Sultan Qaboos Univ Med J, 2020, 20(1): e45-e53.
[4] Ridgeway B, Frick AC, Walter MD. Hysteropexy. A review [J]. Minerva Ginecol, 2008, 60(6): 509-528.
[5] 朱兰, 陈娟. 《盆腔器官脱垂的中国诊治指南(2020年版)》解读[J]. 中华医学信息导报, 2020, 35(15): 17.
[6] 於四军. 女性盆底功能障碍性疾病问卷中文版本研制与中国人群验证[D]. 北京: 北京协和医学院, 2010.
[7] 杨琳, 张金玲, 张立杰, 等. Prolift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. YANG Lin, ZHANG Jinling, ZHANG Lijie, et al. Prognostic factors of patients with severe pelvic organ prolapse by prolift pelvic reconstruction [J]. Chinese Journal of Family Planning & Gynecology, 2017, 9(2): 46-50.
[8] 吴玉英, 赵仁峰, 陈昌益. Prolift全盆底重建术治疗盆腔脏器脱垂的临床研究[J]. 微创医学, 2013, 8(2): 137-139. WU Yuying, ZHAO Renfeng, CHEN Changyi, et al. Clinical study on pelvic organ prolapse treated with Prolift pelvic floor reconstructive surgery [J]. Journal of Minimally Invasive Medicine, 2013, 8(2): 137-139.
[9] Teig CJ, Grotle M, Bond M, et al. Norwegian translation, and validation, of the Pelvic Floor Distress Inventory(PFDI-20)and the Pelvic Floor Impact Questionnaire(PFIQ-7)[J]. Int Urogynecol J, 2017, 28(7): 1005-1017.
[10] Mestre M, Lleberia J, Pubill J, et al. Questionnaires in the assessment of sexual function in women with urinary incontinence and pelvic organ prolapse [J]. Actas Urol Esp, 2015, 39(3): 175-182.
[11] 王卉. 盆底重建术联合盆底康复治疗仪治疗盆底功能障碍性疾病的效果[J]. 实用临床医学, 2017, 18(9): 45-47. WANG Hui. Effect of pelvic floor reconstruction combined with pelvic floor rehabilitation therapy instrument on pelvic floor dysfunction disease [J]. Practical Clinical Medicine, 2017, 18(9): 45-47.
[12] 朱姝. 阴道盆底重建术联合聚丙烯网带尿道中段悬吊术对子宫脱垂合并压力性尿失禁患者的疗效影响[J]. 中国医药指南, 2017,15(8):148-149.
[13] 李玲, 李惠敏, 付明英. 经阴道网片植入盆底重建术治疗盆腔器官脱垂(POP)的应用效果与性功能评价[J]. 中国性科学, 2020, 29(2): 65-68. LI Ling, LI Huimin, FU Mingying. Evaluation of the effect of transvaginal mesh implantation for pelvic floor reconstruction in the treatment of pelvic organ prolapse and its impact on the sexual function [J]. Chinese Journal of Human Sexuality, 2020, 29(02): 65-68.
[14] Long CY, Hsu CS, Wu CH, et al. Three-year outcome of transvaginal mesh repair for the treatment of pelvic organ prolapse [J]. Eur J Obstet Gynecol Reprod Biol, 2012, 161(1): 105-108.
[15] DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy [J]. Am J Obstet Gynecol, 1992, 166(6 Pt 1): 1717-1724.
[16] Costantini E, Porena M, Lazzeri M, et al. Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy [J]. Int Urogynecol J, 2013, 24(9): 1481-1487.
[17] Lowenstein L, Gamble T, Sanses TV, et al. Changes in sexual function after treatment for prolapse are related to the improvement in body image perception [J]. J Sex Med, 2010, 7(2 Pt 2): 1023-1028.
[18] Lowenstein L, Gamble T, Sanses TV, et al. Sexual function is related to body image perception in women with pelvic organ prolapse [J]. J Sex Med, 2009, 6(8): 2286-2291.
[19] Long CY, Hsu CS, Wu CH, et al. Three-year outcome of transvaginal mesh repair for the treatment of pelvic organ prolapse [J]. Eur J Obstet Gynecol Reprod Biol, 2012, 161(1): 105-108.
[20] Hansen BL, Dunn GE, Norton P, et al. Long-term follow-up of treatment for synthetic mesh complications [J]. Female Pelvic Med Reconstr Surg, 2014, 20(3): 126-130.
[21] Gyang AN, Feranec JB, Patel RC, et al. Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh [J]. Int Urogynecol J, 2014, 25(3): 313-318.
[22] Margulies RU, Lewicky-Gaupp C, Fenner DE, et al. Complications requiring reoperation following vaginal mesh kit procedures for prolapse [J]. Am J Obstet Gynecol, 2008, 199(6): 671-678.
[23] 马起鹏. 糖尿病对盆腔器官脱垂患者行网片盆底重建术影响[J]. 临床军医杂志, 2016, 44(12): 1252-1255. MA Qipeng. Short-term clinical effects of pelvic floor reconstruction with mesh in treatment of pelvic organ prolapse complicated with diabetes mellitus [J]. ClinIcal Journal Medical Officer, 2016, 44(12): 1252-1255.
[24] McDermott CD, Terry CL, Woodman PJ, et al. Surgical outcomes following total Prolift: colpopexy versus hysteropexy [J]. Aust N Z J Obstet Gynaecol, 2011, 51(1): 61-66.
[25] 刘增婷, 潘珂, 曹莉莉, 等. 经阴道改良盆底功能重建术中切除子宫与保留子宫的疗效比较[J]. 第三军医大学学报, 2016, 38(11): 1309-1312. LIU Zengting, PAN Ke, CAO Lili, et al. Comparison of uterus conservation versus hysterectomy in transvaginal modified pelvic floor reconstruction [J]. Journal of the Third Military Medical University, 2016, 38(11): 1309-1312.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed