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坐骨棘筋膜固定缝合术治疗Ⅲ度盆腔器官脱垂的疗效评价

Study on ischiospinous ligament fixation in treatment of stage Ⅲ pelvic organ prolapse

摘要:

目的 评价坐骨棘筋膜固定缝合术治疗重度盆腔器官脱垂(POP)的疗效和安全性.方法 回顾性分析北京协和医院2007年3月至2009年12月期间行子宫切除术及坐骨棘筋膜固定缝合术治疗Ⅲ度POP的65例患者的临床资料,其中21例因合并压力性尿失禁同时行经闭孔无张力尿道中段悬吊带术(TVT-O).所有患者均为POP定量分度法(POP-Q)Ⅲ度.记录患者围手术期参数,评价主、客观成功率,以及并发症发生情况.结果 65例患者平均手术时间(71±22)min,平均术中失血量(93±40) ml,无脏器损伤和需要输血的患者.所有患者均顺利恢复自主排尿.2例患者术后并发直径约7cm的盆腔血肿,经保守治疗后消失.术后6周65例患者POP-Q评分客观成功率100%.术后1~3年门诊随访率46.2% (30/65),复发率10%(3/30),但不需要再次手术治疗.所有患者均接受电话随访,中位随访时间20个月(12 ~45个月),主观成功率95.4%( 62/65).术后6周随访时较明显的右侧臀部和大腿疼痛发生率为6.2% (4/65),疼痛视觉模拟评分为3~5分,保守治疗后评分逐渐下降,术后2年内症状消失;坐骨棘筋膜缝合处丝线侵蚀暴露发生率10%(3/30);术后新发尿失禁4.6%( 3/65),新发性交痛12.5%(3/24).结论 坐骨棘筋膜固定缝合术是治疗重度POP的一种安全、疗效满意的术式,值得进一步推广.

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abstracts:

Objective To evaluate the safety and efficacy of ischiospinous ligament fixation in treatment of stage Ⅲ pelvic organ prolapse (POP).Methods Between March 2007 and December 2009,65 patients with stage Ⅲ POP who underwent ischiospinous ligament fixation in Peking Union Medical College Hospital were enrolled in this study.Among 21 cases complicated with stress urinary incontinence (SUI) underwent transobturator tension-free vaginal tape (TVT-O) concomitantly.Clinical parameter associated with perioperation,objective and subjective successful rate and complication were recorded.Results The mean operating time was (71 ±22) min and the mean blood loss was (93 ±40) ml.No intraoperative blood transfusion and viscera injury cases were observed.All patients were able to recover spontaneous micturition.Two cases experienced pelvic hematoma with diameter of 7 cm,after conservative treatment,they all recovered later.The objective success rate was 100% at 6 weeks follow-up by POP-Q scoring.And 46.2% (30/65) were followed up at range of 1 -3 years,recurrence rate were 10% (3/30),and however,no operation were needed.At median of 20 months,all patients were followed up by telephone,the subjective successful rate was 95.4% (62/65).At 6 weeks after operation,6.2% (4/65) patients suffered from lower back pain and right thigh pain,visual analogue scale of pain was at range of 3 to 5,which relieved gradually after treatment and disappeared totally within 2 years.The rate of suture exposure was 10% (3/30),the new urinary incontinence 4.6% (3/65),and the new dyspareunia 12.5% (3/24).Conclusions Ischiospinous ligament fixation is a safe and efficacious management.

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