经阴道植入网片全盆底重建术的疗效及性生活质量评价

发布时间：2019-04-08 10:20

【摘要】：目的:全面探讨经阴道植入网片全盆底重建术治疗盆腔器官脱垂(POP)的疗效、并发症及手术对性生活质量的影响。方法:回顾性分析我院2011年1月至2013年12月160例重度POP行经阴道植入网片全盆底重建术的临床资料并进行随访,观察手术时间、留置尿管时间、术中出血及住院时间等,以了解手术安全性。比较手术前后POP分度评价手术疗效。进行盆底功能影响问卷-7、-20(PFIQ-7、PFDI-20)和盆腔器官脱垂/尿失禁性生活质量问卷-12(PISQ-12),评价手术前后生活质量及性生活质量的改善情况。结果:平均手术时间100.36±40.40分钟,住院时间4.50±1.30天,平均术中出血量150.35±80.30 ml,留置尿管时间3.50±1.50天。术中膀胱损伤4例(2.50%),术后留置尿管1周后好转。随访8~44个月,中位随访时间26月,POP-Q分度及有性生活患者PISQ-12评分较术前明显改善,术后PFIQ-7和PFDI-20评分较术前显著降低,差异均有统计学意义(P0.05)。术后复发13例(8.13%),阴道网片侵蚀5例(3.13%),术后膀胱过度活动症8例(5.00%)。13例中,再次手术8例,有手术客观治愈91.88%(147/160),患者主观满意率86.25%(138/160)。保留子宫组术后PISQ-12评分46.1±4.27分,子宫切除组术后PISQ-12评分28.3±5.26分,两组比较差异有统计学意义(P0.01)。结论:应用阴道网片的全盆底重建术是治疗重度POP的一种微创、有效的手术方式。全盆底重建术时保留子宫可能可以更好地改善性生活质量。
[Abstract]:Aim: to investigate the curative effect, complications and the influence of operation on the quality of sexual life in the treatment of pelvic organ prolapse (POP) by transvaginal reimplantation of the whole pelvic floor. Methods: the clinical data of 160 patients with severe POP from January 2011 to December 2013 were retrospectively analyzed and followed up. The operation time, indwelling catheter time, intraoperative bleeding and hospitalization time were observed. To understand the safety of surgery. POP grading before and after operation was compared to evaluate the curative effect. Pelvic floor functional impact questionnaire-7, 20 (PFIQ-7,PFDI-20) and pelvic organ prolapse / urinary incontinence quality of life questionnaire-12 (PISQ-12) were used to evaluate the improvement of quality of life and sexual life before and after operation. Results: the mean operation time was 100.36 卤40.40 minutes, the hospitalization time was 4.50 卤1.30 days, and the average intraoperative bleeding time was 150.35 卤80.30 ml,. The indwelling catheter time was 3.50 卤1.50 days. Intraoperative bladder injury was found in 4 cases (2.50%) and improved after 1 week indwelling catheter. After 8 months and 44 months follow-up, the median follow-up time was 26 months, the scores of POP-Q and PISQ-12 in patients with sexual life were significantly improved compared with those before operation, and the scores of PFIQ-7 and PFDI-20 after operation were significantly lower than those before operation (P0.05). Postoperative recurrence was found in 13 cases (8.13%), vaginal mesh erosion in 5 cases (3.13%), postoperative bladder hyperactivity in 8 cases (5.00%), reoperation in 8 cases and objective cure in 91.88% (147 / 160). The subjective satisfaction rate was 86.25% (138 / 160). The PISQ-12 score was 46.1 卤4.27 in the hysterectomy group and 28.3 卤5.26 in the hysterectomy group after operation. There was a significant difference between the two groups (P0.01). Conclusion: the total pelvic floor reconstruction with vaginal mesh is a minimally invasive and effective method for the treatment of severe POP. Preserving the uterus during pelvic floor reconstruction may improve the quality of sexual life.
【作者单位】：四川大学华西第二医院;
【分类号】：R713

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