中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
7期
505-509
,共5页
马宁%王凤玫%黄惠娟%宋岩峰
馬寧%王鳳玫%黃惠娟%宋巖峰
마저%왕봉매%황혜연%송암봉
盆腔器官脱垂%尿失禁,压力性%妇科外科手术%骨盆底
盆腔器官脫垂%尿失禁,壓力性%婦科外科手術%骨盆底
분강기관탈수%뇨실금,압력성%부과외과수술%골분저
Pelvic organ prolapse%Urinary incontinence,stress%Gynecologic surgicalprocedures%Pelvic floor
目的 对采用Prolift网片进行盆底重建术中的前盆腔网片放置位置进行改进,探讨其对盆腔器官脱垂(POP)和压力性尿失禁(SUI)的治疗效果.方法 选择2008年7月至2010年9月在南京军区福州总医院因重度POP行Prolift网片盆底重建术的170例患者.术中将前盆腔网片(Prolift-A)的放置位置从膀胱颈部向尿道中段抬高,网片上缘无张力放置于尿道中段下方,盆底重建术的同时不行经闭孔、经阴道尿道中段无张力悬吊带术.患者于术后1、6、12个月通过POP定量分度法( POP-Q)评价解剖复位情况,同时采用排尿困扰量表(UDI-6)、尿失禁影响程度相关问卷(IIQ-7),盆底功能影响问卷简表7(PFIQ-7)评价患者生命质量改善情况.结果 术后6个月168例患者获得随访,术后12个月163例患者获得随访,术后6个月和12个月,患者脱垂器官解剖复位率分别为98.8％ (166/168)和97.5％ (159/163).术中膀胱损伤1例(1/170,0.6％),直肠损伤1例(1/170,0.6％).术后12个月复位失败或复发5例,其中前壁和子宫脱垂各2例,后壁脱垂1例.网片暴露7例,血肿3例.UDI-6、IIQ-7、PFIQ-7评分显示术后生命质量均得到显著改善.79例POP合并SUI患者,尿失禁的治愈率为93.7％ (74/79)；症状性SUI 5例,其中2例需要再行抗SUI手术；有轻微尿失禁但患者主观满意度高并认为不影响生命质量者23例；术后排尿困难7例,通过留置导尿管,5例在10 d内恢复,1例1个月内恢复,1例6个月内恢复；存在尿急迫感、排尿不适症状者11例,尿流缓慢3例.结论 改良Prolifi网片盆底重建术治疗POP的同时对SUI有很好的预防和治疗作用.
目的 對採用Prolift網片進行盆底重建術中的前盆腔網片放置位置進行改進,探討其對盆腔器官脫垂(POP)和壓力性尿失禁(SUI)的治療效果.方法 選擇2008年7月至2010年9月在南京軍區福州總醫院因重度POP行Prolift網片盆底重建術的170例患者.術中將前盆腔網片(Prolift-A)的放置位置從膀胱頸部嚮尿道中段抬高,網片上緣無張力放置于尿道中段下方,盆底重建術的同時不行經閉孔、經陰道尿道中段無張力懸弔帶術.患者于術後1、6、12箇月通過POP定量分度法( POP-Q)評價解剖複位情況,同時採用排尿睏擾量錶(UDI-6)、尿失禁影響程度相關問捲(IIQ-7),盆底功能影響問捲簡錶7(PFIQ-7)評價患者生命質量改善情況.結果 術後6箇月168例患者穫得隨訪,術後12箇月163例患者穫得隨訪,術後6箇月和12箇月,患者脫垂器官解剖複位率分彆為98.8％ (166/168)和97.5％ (159/163).術中膀胱損傷1例(1/170,0.6％),直腸損傷1例(1/170,0.6％).術後12箇月複位失敗或複髮5例,其中前壁和子宮脫垂各2例,後壁脫垂1例.網片暴露7例,血腫3例.UDI-6、IIQ-7、PFIQ-7評分顯示術後生命質量均得到顯著改善.79例POP閤併SUI患者,尿失禁的治愈率為93.7％ (74/79)；癥狀性SUI 5例,其中2例需要再行抗SUI手術；有輕微尿失禁但患者主觀滿意度高併認為不影響生命質量者23例；術後排尿睏難7例,通過留置導尿管,5例在10 d內恢複,1例1箇月內恢複,1例6箇月內恢複；存在尿急迫感、排尿不適癥狀者11例,尿流緩慢3例.結論 改良Prolifi網片盆底重建術治療POP的同時對SUI有很好的預防和治療作用.
목적 대채용Prolift망편진행분저중건술중적전분강망편방치위치진행개진,탐토기대분강기관탈수(POP)화압력성뇨실금(SUI)적치료효과.방법 선택2008년7월지2010년9월재남경군구복주총의원인중도POP행Prolift망편분저중건술적170례환자.술중장전분강망편(Prolift-A)적방치위치종방광경부향뇨도중단태고,망편상연무장력방치우뇨도중단하방,분저중건술적동시불행경폐공、경음도뇨도중단무장력현조대술.환자우술후1、6、12개월통과POP정량분도법( POP-Q)평개해부복위정황,동시채용배뇨곤우량표(UDI-6)、뇨실금영향정도상관문권(IIQ-7),분저공능영향문권간표7(PFIQ-7)평개환자생명질량개선정황.결과 술후6개월168례환자획득수방,술후12개월163례환자획득수방,술후6개월화12개월,환자탈수기관해부복위솔분별위98.8％ (166/168)화97.5％ (159/163).술중방광손상1례(1/170,0.6％),직장손상1례(1/170,0.6％).술후12개월복위실패혹복발5례,기중전벽화자궁탈수각2례,후벽탈수1례.망편폭로7례,혈종3례.UDI-6、IIQ-7、PFIQ-7평분현시술후생명질량균득도현저개선.79례POP합병SUI환자,뇨실금적치유솔위93.7％ (74/79)；증상성SUI 5례,기중2례수요재행항SUI수술；유경미뇨실금단환자주관만의도고병인위불영향생명질량자23례；술후배뇨곤난7례,통과류치도뇨관,5례재10 d내회복,1례1개월내회복,1례6개월내회복；존재뇨급박감、배뇨불괄증상자11례,뇨류완만3례.결론 개량Prolifi망편분저중건술치료POP적동시대SUI유흔호적예방화치료작용.
Objective To evaluate the safety and efficacy of modified Prolift pelvic floor reconstruction with improving the placement of Prolift-A in treatment of severe pelvic floor dysfunction and stress urinary incontinence (SUI).Methods From July 2008 to September 2010,170 cases with severe pelvic organ prolapse(POP) treated by modified Prolift pelvic floor reconstruction surgery in Fuzhou General Hospital were enrolled in this study.The Prolift-A was laid tension-free under the mid-urethra with the position of Prolift-A displaced from the neck of bladder to the mid-urethra.No concomitant tension-free urethra suspender via vagina was performed.Primary outcomes were assessed with POP quantitation ( POPQ) system to evaluate the postoperative anatomical replacement stage.Secondary outcome measure were:urogenital distress inventory 6 ( UDI-6),the incontinence impact questionnaire 7 ( IIQ-7 ) and the pelvic floor incontinence questionnaire 7 (PFIQ-7) to evaluate the impact on life quality at the follow-up of 1,6,12 months.Results At 6 and 12 months after surgery,168 cases and 163 cases were followed up.The anatomical cure rates were 98.8％ (166/168) at 6 months and 97.5％ (159/163) at 12 months,respectively.One case with bladder injury and 1 case with rectum injury were observed.Five cases with recurrence were observed,including 2 cases with anterior vagina prolapse,2 cases with uterine prolapse and 1 case with posterior vagina prolapse.Meanwhile,3 cases with hematoma and 7 cases with mesh erosion were observed.Quality of life of all patients were improved significantly by UDI-6,IIQ-7 and PFIQ-7 scoring system evaluation.Among 79 POP patients with SUI,the cure rate of SUI was 93.7％ (74/79).Of 5 cases with symptomatic SUI,2 cases were needed surgical intervention.Twenty-three cases were found with minimal SUI symptoms and subjective satisfaction without objective influence on quality of life.Seven patients presented dysuria after surgery,5 cases recovered urination with 10 days,1 case recovered with 1 months,and 1 case with 6 months by bladder drainage.Eleven cases with discomfort urination and 3 cases with slow urination were found.Conclusions The modified Prolift pelvic reconstructive surgery was safe and efficacy intervention in treatment of POP and prevention of SUI.
