中国妇幼健康研究
中國婦幼健康研究
중국부유건강연구
CHINESE JOURNAL OF MATERNAL AND CHILD HEALTH RESEARCH
2014年
5期
878-880
,共3页
子宫切除%全盆底重建%盆腔器官脱垂%网片
子宮切除%全盆底重建%盆腔器官脫垂%網片
자궁절제%전분저중건%분강기관탈수%망편
hysterectomy%pelvic floor reconstruction%pelvic organ prolapse ( POP)%mesh
目的：探讨子宫切除与否对全盆底重建术后疗效的影响。方法回顾性分析厦门市妇幼保健院2011年1月至2012年12月91例POP-Q分期Ⅲ～Ⅳ期盆腔器官脱垂患者行全盆底重建术（使用Prolift网片）中切除子宫与否，比较两组术后的疗效。结果切除子宫组的手术时间为（157．30±5．38）分钟，明显长于保留子宫组（132．29±11．88）分钟（t＝41．10，P＜0．001）；切除子宫组的术中出血量为（214．81±18．26）mL，也明显多于保留子宫组（187．14±48．24）mL（t＝45．47，P＜0．001）。保留子宫组术后阴道平均长度长于切除子宫组，两组比较差异有统计学意义（t＝5．45，P＜0．001）。手术后于1、3、6、12个月随访，随访率两组均为100％。两组术后治愈率为100％。切除子宫组有1例网片暴露；保留子宫组无网片暴露。两组均无膀胱、下尿路或肠道损伤，无感染和侵蚀发生，无持续性排尿、排便困难。结论盆底重建手术时保留子宫对维持盆底结构稳定具有一定的意义，近期效果与切除子宫组相似，且手术时间短，有利于降低中老年妇女围手术期的风险，提高手术耐受程度，但还需进一步随访观察长期疗效及远期并发症。
目的：探討子宮切除與否對全盆底重建術後療效的影響。方法迴顧性分析廈門市婦幼保健院2011年1月至2012年12月91例POP-Q分期Ⅲ～Ⅳ期盆腔器官脫垂患者行全盆底重建術（使用Prolift網片）中切除子宮與否，比較兩組術後的療效。結果切除子宮組的手術時間為（157．30±5．38）分鐘，明顯長于保留子宮組（132．29±11．88）分鐘（t＝41．10，P＜0．001）；切除子宮組的術中齣血量為（214．81±18．26）mL，也明顯多于保留子宮組（187．14±48．24）mL（t＝45．47，P＜0．001）。保留子宮組術後陰道平均長度長于切除子宮組，兩組比較差異有統計學意義（t＝5．45，P＜0．001）。手術後于1、3、6、12箇月隨訪，隨訪率兩組均為100％。兩組術後治愈率為100％。切除子宮組有1例網片暴露；保留子宮組無網片暴露。兩組均無膀胱、下尿路或腸道損傷，無感染和侵蝕髮生，無持續性排尿、排便睏難。結論盆底重建手術時保留子宮對維持盆底結構穩定具有一定的意義，近期效果與切除子宮組相似，且手術時間短，有利于降低中老年婦女圍手術期的風險，提高手術耐受程度，但還需進一步隨訪觀察長期療效及遠期併髮癥。
목적：탐토자궁절제여부대전분저중건술후료효적영향。방법회고성분석하문시부유보건원2011년1월지2012년12월91례POP-Q분기Ⅲ～Ⅳ기분강기관탈수환자행전분저중건술（사용Prolift망편）중절제자궁여부，비교량조술후적료효。결과절제자궁조적수술시간위（157．30±5．38）분종，명현장우보류자궁조（132．29±11．88）분종（t＝41．10，P＜0．001）；절제자궁조적술중출혈량위（214．81±18．26）mL，야명현다우보류자궁조（187．14±48．24）mL（t＝45．47，P＜0．001）。보류자궁조술후음도평균장도장우절제자궁조，량조비교차이유통계학의의（t＝5．45，P＜0．001）。수술후우1、3、6、12개월수방，수방솔량조균위100％。량조술후치유솔위100％。절제자궁조유1례망편폭로；보류자궁조무망편폭로。량조균무방광、하뇨로혹장도손상，무감염화침식발생，무지속성배뇨、배편곤난。결론분저중건수술시보류자궁대유지분저결구은정구유일정적의의，근기효과여절제자궁조상사，차수술시간단，유리우강저중노년부녀위수술기적풍험，제고수술내수정도，단환수진일보수방관찰장기료효급원기병발증。
Objective To explore the influence of hysterectomy on pelvic floor reconstruction.Methods Retrospectively analysis was conducted on the clinical data of 91 cases from Xiamen Maternity and Child Health Care Hospital with pelvic organ prolapse ( POP) stagingⅢ-IV according to POP-Q between January 2011 and December 2012.All of 91 cases underwent pelvic floor reconstruction ( using Prolift mesh) , and they were divided into two groups according to undergoing hysterectomy or not.The postoperative efficacy was compared between two groups.Results The average operating time (157.30 ±5.38min) for uteri-removed group was significantly longer than that of uteri-reserved group (132.29 ±11.88min) (t=41.10,P<0.001).The blood loss (214.81 ±18.26mL) of the uteri-removed group was significantly more than that of the uteri-reserved group (187.14 ±48.24mL) (t=45.47, P<0.001).The average vaginal length of the uteri-reserved group was longer than that of the uteri-removed group, and the difference was significant (t=5.45,P<0.001).Two groups were followed up at 1, 3, 6 and 12 month after surgery with follow-up rate of 100%.The curative rate of both groups was 100%.There was 1 case of mesh exposure in the uteri-removed group but none in the uteri-reserved group.No injury to bladder, urinary tract or intestinal, no infection or erosion, no persistent bowel or urinating difficulties was found.Conclusion For pelvic floor reconstruction, preserving uterus, in a certain sense, maintains the stability of pelvic structure.Its short-term effect is similar to uteri-removed group but with shorter operating time, lower risk of perioperation for older women and better surgical tolerance.But further follow-up study is required to explore the long-term results and long-term complications.
