经阴道应用化学合成网片行盆底重建术后复发18例临床分析

发布时间：2018-08-13 15:45

【摘要】：目的探讨经阴道应用合成网片行盆底重建术后复发的原因。方法选取2010年1月至2016年1月18例经阴道应用合成网片行全盆底重建术复发患者,综合评估患者的症状、体征、脱垂程度及再次手术治疗的效果。结果 18例复发患者中,重度子宫脱垂合并轻度阴道前后壁脱垂者5例;重度阴道前后壁脱垂伴其他部位轻度脱垂者4例,阴道穹隆脱垂合并重度阴道前后壁脱垂9例;伴严重排尿困难、排尿不尽2例;伴排便困难2例,均需还纳脱出物排便或排尿;伴压力性尿失禁2例。18例患者均行手术治疗,术中发现子宫颈环结构、位置异常5例,阴道前或后穹隆疝形成3例,既往全盆底重建术中合成网片穿刺部位不准确2例,网片挛缩、移位4例,给予子宫切除、阴道壁修补、疝囊结扎及再次植入网片的盆底重建等手术。平均随访(2.20±1.73)年(1~5年)。依据POP-Q分期法,术后无再次脱垂复发病例,解剖学恢复率100%,主观满意度100%。术后3个月,1例新发膀胱过度活动症,经生物反馈电刺激治疗后好转;1例阴道内线头暴露,剪除线头后恢复良好。结论全盆底重建术后复发原因可能与术中解剖层次不清,网片穿刺部位不准确,固定不牢,术后挛缩、折叠、移位,宫颈环结构处理不到位,以及术后长期腹压增高等有关。
[Abstract]:Objective To investigate the causes of recurrence after transvaginal pelvic floor reconstruction with synthetic mesh.Methods From January 2010 to January 2016,18 patients with recurrence after transvaginal pelvic floor reconstruction with synthetic mesh were selected and their symptoms,signs,prolapse degree and the effect of reoperation were evaluated.Results Among the 18 patients with recurrence,severe uterus was found. There were 5 cases of prolapse with mild anterior and posterior vaginal wall prolapse, 4 cases of severe anterior and posterior vaginal wall prolapse with mild other parts prolapse, 9 cases of vaginal dome prolapse with severe anterior and posterior vaginal wall prolapse, 2 cases of severe dysuria and incomplete urination, 2 cases of dysuria and 2 cases of pressure urinary incontinence. Surgical treatment was performed in all patients. The structures of cervical ring were found in 5 cases with abnormal position, anterior or posterior fornix hernia in 3 cases, inaccurate puncture site of synthetic mesh in 2 cases, mesh contracture and displacement in 4 cases, hysterectomy, vaginal wall repair, ligation of hernia sac and pelvic floor reconstruction with reimplantation mesh were performed. Mean follow-up (2. According to POP-Q staging, there was no recurrence of prolapse, the anatomical recovery rate was 100%, and the subjective satisfaction rate was 100%. Three months after operation, 1 case of new bladder hyperactivity was improved after biofeedback electrical stimulation treatment; 1 case of vaginal internal line head was exposed and recovered well after removal of line head. It may be related to unclear anatomical layers, inaccurate site of mesh puncture, improper fixation, postoperative contracture, folding, displacement, inadequate treatment of cervical ring structure, and prolonged postoperative abdominal hypertension.
【作者单位】：中国医科大学附属盛京医院妇产科;中国医科大学研究生院;
【基金】：科技部国家科技支撑计划(2014BAI05B02) 国家科技部十二五“重大新药创制”科技重大专项(2012ZX09401004)
【分类号】：R713

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