全子宫切除术后穹隆疝的手术处理及临床分析

发布时间：2018-06-18 12:09

本文选题：子宫切除术后 + 穹隆疝　；参考：《中国妇产科临床杂志》2017年02期

【摘要】：目的探讨因子宫脱垂或其他因素行全子宫切除术后发生穹隆疝的处理方式。方法对2011年1月至2015年12月就诊于中国医科大学附属盛京医院行全子宫切除术后发生盆腔器官脱垂107例及其中的80例穹隆疝患者的手术处理方式进行回顾性分析。结果 107例患者中,单纯膀胱膨出或直肠膨出27例;以穹隆膨出为主,伴或不伴有膀胱和直肠膨出80例。80例患者中,子宫脱垂行全子宫切除32例,其他原因行全子宫切除48例;重度压力性尿失禁14例,尿动力学提示隐匿性尿失禁3例;行经阴道置入网片的盆底重建术76例,其中全盆底重建术56例,中盆腔重建术20例;2例腹腔镜下阴道骶骨固定术,1例单纯疝囊修补术,1例前盆底重建术+疝囊修补术。17例压力性尿失禁患者中,16例术中同时行TVT-O术。随访至2016年12月,平均随访时间38个月,无复发病例,3例患者出现网片暴露,1例隐匿性尿失禁患者于术后1年因尿失禁症状较重,行TVT-O手术。结论置入网片的盆底重建术是治疗子宫切除术后阴道穹隆疝的一种有效的手术方式,术前根据穹隆疝及合并阴道前后壁脱垂的程度选择恰当的手术重建方式。对于术前合并压力性尿失禁或隐匿性尿失禁患者术中应同时行TVT-O手术。
[Abstract]:Objective to explore the management of fornix hernia after hysterectomy due to uterine prolapse or other factors. Methods from January 2011 to December 2015, 107 patients with pelvic organ prolapse after total hysterectomy and 80 patients with dome hernia were retrospectively analyzed. Results of 107 cases, 27 cases were simple cystocele or rectocele, 80 cases with or without vesical and rectocele, 32 cases with uterine prolapse and 48 cases with total hysterectomy for other reasons. There were 14 cases of severe stress urinary incontinence, 3 cases of occult urinary incontinence, 76 cases of pelvic floor reconstruction via vaginal mesh placement, 56 cases of total pelvic floor reconstruction. 20 cases of pelvic reconstruction 2 cases of laparoscopic vaginal sacrum fixation 1 case of simple hernia sac repair 1 case of anterior pelvic floor reconstruction hernia sac repair. 17 cases of stress urinary incontinence were treated with TVT-O simultaneously. The average follow-up time was 38 months until December 2016. There were 3 cases with no recurrence and one patient with occult urinary incontinence underwent TVT-O operation because of the severe symptoms of urinary incontinence one year after operation. Conclusion the pelvic floor reconstruction with mesh placement is an effective method for the treatment of vaginal fornix hernia after hysterectomy. According to the degree of fornix hernia and associated prolapse of the anterior and posterior wall of vagina, the appropriate surgical reconstruction method is selected before operation. TVT-O should be performed simultaneously in patients with pressure-induced urinary incontinence or occult urinary incontinence.
【作者单位】：中国医科大学附属盛京医院妇科盆底疾病病房辽宁省盆底诊治中心;
【基金】：中华预防医学会科研基金支持项目(20130606) 科技部国家科技支撑计划课题(2014BAI05B02)
【分类号】：R713.42

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