CAJ | 학술논문

目的：比较Prolift系统盆底重建术与常规阴式手术治疗盆腔器官脱垂的临床疗效。方法回顾性分析2009年6月至2011年3月重庆医科大学附属第一医院收治入院的盆腔器官脱垂患者64例，将其分为Prolift系统盆底重建组（重建组）32例和阴式子宫切除加阴道前后壁修补术组（常规组）32例，比较两组患者一般情况、围术期及随访资料，并进行统计学处理，分析其手术效果。结果两组患者的年龄、体质量指数、绝经年龄、孕产次及子宫脱垂程度差异均无统计学意义（P＞0．05），所有患者手术均获成功，均未出现严重的术后并发症。重建组患者在术中出血量、平均手术时间、肛门排气时间、术后最高体温、留置尿管天数以及术后住院天数等指标上均明显优于常规组（ P＜0．05）。重建组随访率93．8％（30/32），术后1例（3．1％）复发，1例（3．1％）补片侵蚀，1例（3．1％）新发下尿路症状，19例恢复性生活者，1例性交痛，2例性交不适感；常规组随访率90．6％（29/32），术后8例（25％）复发，4例（12．5％）新发下尿路症状，16例恢复性生活者，3例性交痛，5例性交不适感。术后3个月及6个月两组间客观治愈率比较差异无统计学意义（P＞0．05）；术后12个月两组间客观治愈率比较差异有统计学意义（P＜0．05），重建组客观治愈率高于常规组。结论 Prolift系统盆底重建术较常规阴式手术在治疗盆腔脏器脱垂中能更好地恢复盆底解剖结构和功能，手术创伤小，短期安全有效，但远期疗效仍需进一步研究。
목적：비교Prolift계통분저중건술여상규음식수술치료분강기관탈수적림상료효。방법회고성분석2009년6월지2011년3월중경의과대학부속제일의원수치입원적분강기관탈수환자64례，장기분위Prolift계통분저중건조（중건조）32례화음식자궁절제가음도전후벽수보술조（상규조）32례，비교량조환자일반정황、위술기급수방자료，병진행통계학처리，분석기수술효과。결과량조환자적년령、체질량지수、절경년령、잉산차급자궁탈수정도차이균무통계학의의（P＞0．05），소유환자수술균획성공，균미출현엄중적술후병발증。중건조환자재술중출혈량、평균수술시간、항문배기시간、술후최고체온、류치뇨관천수이급술후주원천수등지표상균명현우우상규조（ P＜0．05）。중건조수방솔93．8％（30/32），술후1례（3．1％）복발，1례（3．1％）보편침식，1례（3．1％）신발하뇨로증상，19례회복성생활자，1례성교통，2례성교불괄감；상규조수방솔90．6％（29/32），술후8례（25％）복발，4례（12．5％）신발하뇨로증상，16례회복성생활자，3례성교통，5례성교불괄감。술후3개월급6개월량조간객관치유솔비교차이무통계학의의（P＞0．05）；술후12개월량조간객관치유솔비교차이유통계학의의（P＜0．05），중건조객관치유솔고우상규조。결론 Prolift계통분저중건술교상규음식수술재치료분강장기탈수중능경호지회복분저해부결구화공능，수술창상소，단기안전유효，단원기료효잉수진일보연구。
Objective To investigate the clinical effectiveness of pelvic floor reconstruction surgery with Prolift system and rou‐tine transvaginal surgery in treating pelvic organ prolapse (POP) .Methods We analyzed an retrospective study of 64 patients with POP patients from June 2009 to March 2011 .All patients were divided into two groups ,32 cases of the reconstruction group were treated with pelvic floor reconstruction surgery with Prolift system ,as reconstruction group ,the other 32 cases in routine treatment group with routine transvaginal surgery ,which inclouded transvaginal hysterectomy ,repair of anterior and posterior vaginal wall ,as routine treatment group ,the pre operative ,peri operative data and follow up results were compared between the two groups and to evaluate the outcomes of the two groups after surgery .Results The age ,body mass index ,menopause age ,pregnant times and the degree of uterus prolapse were no significant difference between the two groups (P>0 .05) .The operation of all the patients were successful .No patient were infected after surgery ,no vascular injury ,or urinary system injury ,or rectal injury occurred .Reconstruc‐tion group showed more significant in the amounts of blood loss ,average operation time ,anal exsufflation time ,mean of highest postoperative body temperature ,the urinary canal indwelling time and the postoperative hospitalization time compared with routine treatment group(P<0 .05) .The follow up rate was 93 .8% (30/32)in reconstruction group ,1 patient (3 .1% )experienced recur‐rence ,1 patient(3 .1% )experienced mesh erosion ,1 patient(3 .1% ) experienced new urinary tract symptoms ,of 19 patients who were sexually active ,1 patient suffered from algopareunia and 2 from sexual intercourse discomfort respectively .The follow up rate was 90 .6% (29/32)in routine treatment group ,4 patients(12 .5% )experienced new urinary tract symptoms ,8 patients(25% )expe‐rienced recurrence ,of 16 patients who were sexually active ,3 patients suffered from algopareunia and 5 from sexual intercourse dis‐comfort .The objective cure rates at 3 and 6 months after operation was no significant difference between the two groups (P>0 .05) ,but the objective cure rate at 12 months after operation was significantly different between the two groups (P<0 .05) .The objective curative rate in reconstruction group was significantly higher than that in routine treatment group .Conclusion Pelvic floor reconstruction surgery with Prolift system is a safe and effective methods of minimally invasive surgery ,patients had better regain integrity of anatomical structure and functions of pelvic floor in short term for POP when compared with routine transvaginal sur‐gery ,but its long term study is still needed .