腹腔镜阴道骶骨固定术治疗盆腔器官脱垂的疗效评价

发布时间：2018-07-22 16:30

【摘要】：目的:评价腹腔镜阴道骶骨固定术(LSC)治疗盆腔器官脱垂的临床疗效。方法:2009年1月至2015年5月对100例中盆腔缺陷为主的盆腔器官脱垂患者行LSC,分离右侧盆腔后腹膜,将网片远端固定于阴道前后壁、阴道穹隆;近端网片固定于骶前纵韧带,网片无张力置于腹膜后。采用手术成功、手术并发症及盆底功能障碍问卷(pelvic floor distress inventory-short form 20,PFDI-20)评价疗效。结果:手术时间165.7±48.0分钟,术中出血量119.5±108.5 ml。术后留置尿管时间4.3±2.4天,排便时间4.7±1.3天,住院9.6±3.6天。手术均成功,无复发病例,新发尿失禁17例。术后并发症共12例,包括暂时性尿潴留1例,肠梗阻3例,发热1例,术后网片侵蚀6例,术后右下腹坠痛再次手术网片取出术1例。100例随访31.9±17.6月。PFDI-20术后评分较术前有显著性差异(3.46±3.56分vs 17.98±8.24分,P0.001)。结论:LSC治疗中盆腔缺陷为主的盆腔器官脱垂,安全,效果好,能显著改善患者盆底功能障碍症状。
[Abstract]:Objective: to evaluate the clinical effect of laparoscopic vaginal sacral fixation (LSC) for pelvic organ prolapse. Methods: from January 2009 to May 2015, 100 cases of pelvic organ prolapse with pelvic defects were treated with LSC. the right pelvic retroperitoneal membrane was separated, the distal end of the mesh was fixed on the anterior and posterior wall of vagina, vagina fornix, and the proximal mesh was fixed on the anterior sacral longitudinal ligament. The mesh is tensionless behind the peritoneum. The efficacy was evaluated by (pelvic floor distress inventory-short form 20 / PFDI-20), surgical complications and pelvic floor dysfunction questionnaire (pelvic floor distress inventory-short form 20 PFDI-20). Results: the operative time was 165.7 卤48.0 minutes and the intraoperative bleeding was 119.5 卤108.5 ml. The postoperative indwelling time was 4.3 卤2.4 days, the defecation time was 4.7 卤1.3 days, and the hospitalization was 9.6 卤3.6 days. All operations were successful, no recurrence cases, 17 cases of new urinary incontinence. Postoperative complications included temporary urinary retention (1 case), intestinal obstruction (3 cases), fever (1 case), and postoperative mesh erosion (6 cases). There was a significant difference in the postoperative score of PFDI-20 (3.46 卤3.56 vs 17.98 卤8.24, P 0.001) between the right lower abdominal pain and reoperation mesh extraction in 1 case. 100 cases were followed up 31.9 卤17.6 months. PFDI-20 score was significantly higher than that before operation (3. 46 卤3. 56 vs 17. 98 卤8. 24). Conclusion the pelvic organ prolapse with pelvic defect is safe and effective in the treatment of the pelvic floor dysfunction. It can significantly improve the symptoms of pelvic floor dysfunction.
【作者单位】：四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室;北京大学人民医院;
【分类号】：R713

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