使用网片盆底重建手术后复发病例分析

发布时间：2018-05-09 15:17

  本文选题：网片 + 盆底重建手术　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:探讨导致使用网片盆底手术重建术后复发的相关因素、防范措施及复发后的治疗,以指导临床工作。方法:回顾性分析大连医科大学附属大连市妇产医院妇科2008年3月至2016年11月使用网片行盆底重建手术治疗的复发性女性盆底功能障碍性疾病行二次手术的7例患者临床资料。结果:7例病例中,病程5～12年,平均(8.6±2.37)年,随访时间30～108个月,平均(78.4± 29)个月,第一次手术年龄57～73岁,平均(62 ±5.7)岁,第二次手术年龄58～75岁,平均(64.6±6.1)岁,复发相关高危因素:均为老年绝经女性,绝经年龄41～57岁,平均(49±5.4)岁,绝经时间3～25年,平均(13±9.1)年,均未行激素替代治疗;孕次1～4次,平均(3.3±1.1)次,产次1～3次,平均(1.6±0.8)次,均为阴道分娩。便秘42.9%(3/7),阴道内均有压迫感,高血压71.4%(5/7),糖尿病28.6%(2/7),压力性尿失禁(Stress Urinary Incontinence,SUI)57.1%(4/7),重症肌无力 14.3%(1/7),脐疝 14.3%(1/7)。病例一首次行阴式全子宫切除术+加用网片的阴道前壁修补术+阴道后壁传统修补术,术后7个月复发,术后8个月因阴道后壁脱垂复发后行加用网片的阴道后壁修补术;病例二首次行保留子宫的Prolift全盆底重建术+无张力尿道吊带术一闭孔系统(tension—free vaginal tape—obturator,TVT-O),术后 38 个月复发,术后 44个月因子宫脱垂复发行腹腔镜下全子宫切除+双侧附件切除术+加用网片的阴道骶前固定术;病例三曾行全子宫切除术,首次行全盆底重建术,术后2个月复发,术后12个月因阴道穹隆脱垂复发行疝囊高位结扎术+前盆重建术;病例四首次行加用补片的阴道前壁修补术,术后即复发SUI,术后24个月行TVT-O;病例五首次行加用补片的阴道前壁修补术+TVT-O,术后18个月复发,术后24个月因子宫脱垂复发行阴式全子宫切除术;病例六首次行加用补片的阴道前壁修补术,术后49个月复发,术后51个月因子宫及阴道后壁脱垂复发行阴式全子宫切除术;病例七首次行保留子宫的全盆重建术,术后6个月复发,术后54个月因子宫及阴道前壁脱垂复发行阴式全子宫切除术+传统阴道前壁修补术;两次手术后均取得了满意的效果。结论:本组资料中使用网片行盆底重建手术后复发行二次手术的发生率1.7%。年龄大、经阴道分娩、产次、绝经、术前脱垂程度高、合并内科合并症、便秘、术前评估不充分、术式选择不正确、术者手术操作不到位、网片放置及固定的位置欠缺等是术后复发高危因素。复发后手术方式的选择应从多方面进行考量,只有制定出适合的个体化治疗方案才能达到最佳的治疗效果。
[Abstract]:Objective: to explore the related factors, preventive measures and treatment of postoperative recurrence after pelvic floor reconstruction with mesh for guiding clinical work. Methods: the clinical data of 7 patients with recurrent female pelvic floor dysfunction who underwent pelvic floor reconstruction from March 2008 to November 2016 were retrospectively analyzed in Department of Gynecology and Gynecology of Dalian Municipal Gynecology Hospital affiliated to Dalian Medical University. Results among the 7 cases, the course of disease ranged from 5 to 12 years, with an average of 8.6 卤2.37 years. The follow-up period was 30 ~ 108 months, with an average of 78.4 卤29 months. The age of the first operation was 5773 years (mean 62 卤5.7) years, and the age of the second operation was 5875 years with an average of 64.6 卤6.1 years. The high risk factors of recurrence were all elderly menopausal women, the menopausal age was 41 ~ 57 years (mean 49 卤5.4) years, the menopausal time ranged from 3 to 25 years, the average time was 13 卤9.1 years, the number of pregnancies was 4 times (mean 3.3 卤1.1), the average number of births was 1.3 times (1.6 卤0.8). All were vaginal parturition. Constipation 42.9% / 7, vaginal pressure was felt, hypertension 71.4%, diabetes 28.620 / 7, stress Urinary incontinence 57.1%, myasthenia gravis 14.33% 7 / 7, umbilical hernia 14.33% 1 / 7, umbilical hernia 14.33% 7 / 7, and stress Urinary incontinence 57.1% 7 / 7, stress incontinence 57.1%, myasthenia gravis 14.33% 7 / 7, umbilical hernia 14.33% 1 / 7, stress Urinary incontinence 57.1% 7 / 7, myasthenia gravis 14.33 / 7, umbilical hernia 14.33 / 7. The first case was treated with vaginal anterior wall repair by vaginal hysterectomy and mesh for the first time. The posterior wall of vagina recurred 7 months after operation and 8 months after the posterior wall prolapse of vagina, the posterior wall of vagina was repaired with mesh. In case 2, Prolift total pelvic floor reconstruction with uterine preservation was performed for the first time. The tension-free vaginal tape-obturator TVT-OG system was performed without tension urethral sling. It recurred 38 months after operation. The vaginal presacral fixation was performed 44 months after hysterectomy due to uterine prolapse, total hysterectomy by laparoscope with bilateral appendage hysterectomy with mesh, total hysterectomy with total pelvic floor reconstruction for the first time, and recurrence 2 months after operation. 12 months after operation, the herniation sac was reissued for the vaginal fornix, and the anterior vaginal wall was repaired with patch for the first time in case 4, the anterior pelvic reconstruction was performed with high ligation of hernia sac. In case 5, TVT-O was performed for the first time and the vaginal anterior wall was repaired with patch for the first time. It recurred at 18 months after operation, and the vaginal hysterectomy was released 24 months after operation because of uterine prolapse. In case 6, vaginal anterior wall was repaired with patch for the first time, and relapsed after 49 months. Vaginal hysterectomy was released 51 months after operation due to prolapse of the uterus and posterior wall of vagina. In case 7, hysterectomy was performed for the first time. It recurred at 6 months after operation. After 54 months of operation, vaginal hysterectomy was performed with vaginal anterior wall repair due to prolapse of uterus and anterior wall of vagina, and satisfactory results were obtained after both operations. Conclusion: the incidence of recurrence after pelvic floor reconstruction was 1.7%. Age, vaginal delivery, labor, menopause, high degree of prolapse before operation, complication of internal medicine, constipation, inadequate preoperative evaluation, incorrect choice of operation, improper operation of the operator, Mesh placement and lack of fixed position are high risk factors for postoperative recurrence. The choice of operation mode after recurrence should be considered from many aspects, and the best treatment effect can be achieved only by formulating suitable individualized treatment plan.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713

【参考文献】

中国期刊全文数据库 前4条

1 路畅;魏薇;卢丹;;经阴道传统手术治疗盆腔脏器脱垂的复发情况及危险因素[J];中国临床医生杂志;2015年12期

2 张正宇;;雌三醇软膏配伍红霉素软膏在绝经后妇女子宫脱垂术前的临床应用[J];中外医学研究;2015年25期

3 李明;吴氢凯;贾翔;;女性压力性尿失禁手术后复发的处理对策[J];中国计划生育和妇产科;2015年08期

4 胡昌东;陈义松;易晓芳;丁景新;冯炜炜;尧良清;黄健;张英;胡卫国;朱芝玲;华克勤;;三种手术治疗重度盆腔器官脱垂的疗效观察及其复发因素分析[J];中华妇产科杂志;2011年02期

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