摘要
目的探讨腹腔镜下应用Y型聚丙烯网片治疗子宫和阴道穹窿脱垂的疗效。方法 2010年6月-2012年12月,于腹腔镜下采用Y型聚丙烯网片行阴道、子宫-骶骨固定术治疗24例子宫和阴道穹窿脱垂患者。患者年龄35～60岁,平均48.6岁。病程2～8年,平均5年。根据国际节制协会(ICS)制定的盆腔器官脱垂(pelvic organs prolapse,POP)定量(POP-Q)分度标准进行评定,其中子宫脱垂Ⅱ度16例,Ⅲ度8例;阴道脱垂Ⅰ度15例,Ⅱ度7例,Ⅲ度2例。术后定期随访,根据POP生活质量问卷(P-QOL)量表行主观疗效评价;根据POP-Q分度标准进行客观治愈评价。结果患者均顺利完成手术。手术时间22～68 min,平均33 min;失血量30～80 mL,平均51 mL;尿管放置时间3～7 d,平均4 d;住院时间4～9 d,平均6.8 d。24例均获随访,随访时间3～12个月,平均9个月;其中2例随访时间<6个月。患者拔出尿管后均能正常排尿,残余尿量在正常范围。无网片侵蚀及性生活不适,无阴道及肛门下坠感;术后3、6、12个月P-QOL量表评分均显著优于术前,差异均有统计学意义(P<0.05);术后各时间点间比较差异无统计学意义(P>0.05)。术后6个月POP-Q分度标准评价为0度19例,Ⅰ度3例,客观治愈率91.7%(22/24,2例随访时间<6个月者按复发计)。随访期间无复发。结论腹腔镜下应用Y型聚丙烯网片治疗子宫和阴道穹窿脱垂是一种安全、有效方法,尤其适用于要求保留子宫、对性生活要求较高的患者。
Objective To investigate the effectiveness of laparoscopic Y-shaped polypropylene mesh in the treatment of uterine and vaginal vault prolapse. Methods Between June 2010 and December 2012, 24 patients with uterine and vaginal vault prolapse were treated by laparoscopic pelvic reconstruction （vagina and uterus-sacral fixation） with Y-shaped polypropylene mesh. The age of patients was 35-60 years （mean, 48.6 years）. The disease duration was 2-8 years （mean, 5 years）. According to the pelvic organ prolapse quatitative （POP-Q） classification by International Continence Society （ICS）, 16 cases were classified as uterine prolapsed degree II and 8 cases as degree III; 15 cases were classified as vaginal prolapse degree I, 7 cases as degree II, and 2 cases as degree III. All patients received postoperative follow-up regularly. Subjective evaluation was done based on prolapse quality of life questionnaire （P-QOL）, and objective evaluation based on POP-Q classification. Results All the patients were operated successfully. The operation time was 22-68 minutes （mean, 33 minutes）; the blood loss was 30- 80 mL （mean, 51 mL）; the indwelling urethral catheter remain was 3-7 days （mean, 4 days）; and the hospitalization days were 4-9 days （mean, 6.8 days）. Twenty-four patients were followed up 3-12 months （mean, 9 months）, of whom, 2 were followed up less than 6 months. All patients had normal urination after withdrawal of urethral catheter, and the residual urine volume was in normal range. No patients had mesh erosion and discomfort during sex, vaginal and anal bearing down. The P-QOL scores at 3, 6, and 12 months after operation were significantly improved when compared with the preoperative value （P 〈 0.05）; but there was no significant difference among 3, 6, and 12 months after operation （P 〉 0.05）. The postoperative POP-Q classification was degree 0 in 19 cases and degree I in 3 cases, and the objective cure rate was 91.7%. No recurrence was found during follow- up. Conc
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第9期1106-1109,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
上海奉贤区科学技术委员会基金资助项目(2012-2015)~~
关键词
腹腔镜
Y型聚丙烯网片
子宫脱垂
阴道穹窿脱垂
Laparoscope
Y-shaped polypropylene mesh
Uterine prolapse
Vaginal vault prolapse
