补片应用于盆底功能障碍性疾病的临床效果观察

目的:探讨补片在女性盆底功能障碍性疾病治疗中的应用情况。方法:回顾性分析该院妇科2006～2009年因盆底功能障碍性疾病手术应用补片者患者67例。行子宫切除38例,保留子宫19例,宫颈部分截除术10例。行全盆底悬吊术、阴道前壁补片+阴道后壁修补、阴道前壁补片术共61例,其中34例合并压力性尿失禁者同时行TVT-O术,6例单行TVT-O术。术后对患者进行定期随访。结果:67例患者手术均成功进行。手术时间平均为129.8 min(30～240 min),补片放置时间平均20.1min(10～30min)。术中出血平均149.4ml(50～300 ml)。术后平均住院时间6.4天(3～11天)。67例患者平均随访1～5年,术后盆腔器官脱垂症状全部得以纠正,无1例复发;尿失禁患者手术后1例复发,2例症状改善,其余症状消失。4例出现补片侵蚀现象,1例发生感染。结论:盆底悬吊术是一种能治疗多区域复杂型盆腔器官脱垂的新型盆底重建微创手术,能实现盆底解剖和功能重建。补片在盆腔脏器脱垂手术中的应用虽有一定的术后并发症,但方法简单,操作容易,患者耐受性好,值得推广与应用。

Observation on the clinical efficacy of mesh for pelvic floor dysfunction

Objective:To explore the application of mesh in treatment of female pelvic floor dysfunction.Methods:Sixty-seven patients with pelvic floor dysfunction who were treated with mesh in department of gynecology in the hospital from 2006 to 2009 were analyzed retrospectively,including 38 patients undergoing hysterectomy,19 patients reserving uteri and 10 patients undergoing partial resection of cervix.Sixty-one patients underwent pelvic floor ventrofixation,anterior vaginal wall patch and posterior vaginal wall repair,anterior vaginal wall patch,respectively,and 34 patients who were combined with stress urinary incontinence underwent TVT-O surgery simultaneously,6 patients underwent single TVT-O surgery.All the patients were followed up regularly after surgery.Results:The operation was successfully completed for all the patients.The mean operation time was 129.8 minutes(30-240 minutes),the average placement time of mesh was 20.1 minutes(10-30 minutes).The mean amount of blood loss during operation was 149.4 ml(50-300 ml).The mean hospitalization time after operation was 6.4 days(3-11 days).All the patients were followed up for 1-5 years,the symptoms of pelvic organ prolapse were corrected completely after operation,no recurrence occurred;among the patients with urinary incontinence,one patient recurred,the symptoms of two patients were improved,and the symptoms of the other patients disappeared.Patch erosion occurred in four patients,and one patient was found with infection.Conclusion:Pelvic floor ventrofixation is a minimally invasive surgery of new pelvic floor reconstruction to treat multi-regional and complex pelvic organ prolapse and realize pelvic anatomical and functional reconstruction.The pelvic floor reconstructive surgery with mesh may bring some postoperative complications,but the method is simple,easy to operate,and well tolerated in patients,so it is worthy to be popularized and applied in clinic.