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经阴道Prosima网片联合高位骶韧带悬吊术治疗重度盆腔器官脱垂的临床研究

Transvaginal Prosima mesh and high uterosacral ligament suspension in the treatment of severe pelvic organ prolapsey

摘要:

目的 探讨经阴道Prosima网片联合高位骶韧带悬吊术(HUS)治疗重度盆腔器官脱垂(POP)的临床疗效.方法 回顾性分析2010年7月至2012年2月在解放军总医院附属第一医院行经阴道Prosima网片联合HUS治疗的70例重度POP患者的临床资料.记录患者围手术期参数.患者术后1个月及2~3个月时实施两次会阴超声检查,测量前路正中矢状位网片长度.采用盆底功能障碍问卷简表20( PFDI-20)和盆底功能影响问卷简表7(PFIQ-7)对患者的症状及生命质量改善情况进行主观疗效评价,术前PFIQ-7及PFDI-20评分平均54及51分.手术客观治愈率标准为脱垂最远端与处女膜水平的距离≤0 cm.结果 70例患者平均手术时间( 195±47) min,术中平均出血量(160±64) ml.70例患者均获随访,平均随访时间13个月(2~19个月).7例患者有<1 cm2的网片暴露.客观治愈率100%,术后PFIQ-7及PFDI-20评分平均为19分,与术前比较,差异均有统计学意义(P<0.05),生命质量明显改善.前路Prosima网片放置1个月时会阴超声测量平均前后径3.5 cm,放置2~3个月时为2.8 cm,比原始网片分别缩短2.5 cm和3.2 cm.结论 Prosima网片联合HUS治疗重度POP,近期疗效可靠、安全、并发症少.尽管前路网片术后2~3个月时皱缩明显,但不影响手术效果.

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abstracts:

Objective To study the efficacy of performing transvaginal Prosima mesh with high uterosacral ligament suspension (HUS) in treatment of severe pelvic organ prolapse (POP).Methods From July 2010 to February 2011,70 patients with severe POP underwent transvaginal prosima mesh with HUS in First Affiliated Hospital,General Hospital of People's Liberation Army.Clinical parameters of perioperation were collected.After 1 month and 2 - 3 months,perineal two-dimensional ultrasound examination was performed to measure mesh length in midsagittal plane.Validated prolapse quality of life questionnaires,pelvic floor distress inventsry short form 20 (PFDI-20) and pelvic floor impact questionnaire short form 7 (PFIQ-7) were used to evaluate the therapeutic effect.The mean results of pre-operative PFIQ-7 and PFDI-20 was 54 and 51,respectively.Results Median operation time was ( 195 ± 47 ) min and median blood loss was (160 ±64) ml.All the patients were followed for a mean time of 13 months (2 - 19 months).Seven cases were found with mesh exposure with less than 1 cm2.The objective cure rate was 100%.The mean score of post-operative PFIQ-7 and PFDI-20 were both 19,which were significantly lower than those of preoperation ( P < 0.05 ).Anterior Prosima mesh was 3.5 cm at 1 month by ultrasound examination,and the second result of ultrasound scans was 2.8 cm at 2 - 3 month,which were both shortened 2.5 cm and 3.2 cm when compared with that of original size.Conclusions Transvaginal Prosima mesh placement with HUS is a safe and efficient surgery with less complication.Although mesh became shorter after 2 - 3 month,it did not affect surgery efficacy.

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