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改良Prolift网片盆底重建术对压力性尿失禁防治作用的探讨

Study on modified Prolift for pelvic floor reconstruction in the prevention of stress urinary incontinence

摘要:

目的 对采用Prolift网片进行盆底重建术中的前盆腔网片放置位置进行改进,探讨其对盆腔器官脱垂(POP)和压力性尿失禁(SUI)的治疗效果.方法 选择2008年7月至2010年9月在南京军区福州总医院因重度POP行Prolift网片盆底重建术的170例患者.术中将前盆腔网片(Prolift-A)的放置位置从膀胱颈部向尿道中段抬高,网片上缘无张力放置于尿道中段下方,盆底重建术的同时不行经闭孔、经阴道尿道中段无张力悬吊带术.患者于术后1、6、12个月通过POP定量分度法( POP-Q)评价解剖复位情况,同时采用排尿困扰量表(UDI-6)、尿失禁影响程度相关问卷(IIQ-7),盆底功能影响问卷简表7(PFIQ-7)评价患者生命质量改善情况.结果 术后6个月168例患者获得随访,术后12个月163例患者获得随访,术后6个月和12个月,患者脱垂器官解剖复位率分别为98.8% (166/168)和97.5% (159/163).术中膀胱损伤1例(1/170,0.6%),直肠损伤1例(1/170,0.6%).术后12个月复位失败或复发5例,其中前壁和子宫脱垂各2例,后壁脱垂1例.网片暴露7例,血肿3例.UDI-6、IIQ-7、PFIQ-7评分显示术后生命质量均得到显著改善.79例POP合并SUI患者,尿失禁的治愈率为93.7% (74/79);症状性SUI 5例,其中2例需要再行抗SUI手术;有轻微尿失禁但患者主观满意度高并认为不影响生命质量者23例;术后排尿困难7例,通过留置导尿管,5例在10 d内恢复,1例1个月内恢复,1例6个月内恢复;存在尿急迫感、排尿不适症状者11例,尿流缓慢3例.结论 改良Prolifi网片盆底重建术治疗POP的同时对SUI有很好的预防和治疗作用.

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abstracts:

Objective To evaluate the safety and efficacy of modified Prolift pelvic floor reconstruction with improving the placement of Prolift-A in treatment of severe pelvic floor dysfunction and stress urinary incontinence (SUI).Methods From July 2008 to September 2010,170 cases with severe pelvic organ prolapse(POP) treated by modified Prolift pelvic floor reconstruction surgery in Fuzhou General Hospital were enrolled in this study.The Prolift-A was laid tension-free under the mid-urethra with the position of Prolift-A displaced from the neck of bladder to the mid-urethra.No concomitant tension-free urethra suspender via vagina was performed.Primary outcomes were assessed with POP quantitation ( POPQ) system to evaluate the postoperative anatomical replacement stage.Secondary outcome measure were:urogenital distress inventory 6 ( UDI-6),the incontinence impact questionnaire 7 ( IIQ-7 ) and the pelvic floor incontinence questionnaire 7 (PFIQ-7) to evaluate the impact on life quality at the follow-up of 1,6,12 months.Results At 6 and 12 months after surgery,168 cases and 163 cases were followed up.The anatomical cure rates were 98.8% (166/168) at 6 months and 97.5% (159/163) at 12 months,respectively.One case with bladder injury and 1 case with rectum injury were observed.Five cases with recurrence were observed,including 2 cases with anterior vagina prolapse,2 cases with uterine prolapse and 1 case with posterior vagina prolapse.Meanwhile,3 cases with hematoma and 7 cases with mesh erosion were observed.Quality of life of all patients were improved significantly by UDI-6,IIQ-7 and PFIQ-7 scoring system evaluation.Among 79 POP patients with SUI,the cure rate of SUI was 93.7% (74/79).Of 5 cases with symptomatic SUI,2 cases were needed surgical intervention.Twenty-three cases were found with minimal SUI symptoms and subjective satisfaction without objective influence on quality of life.Seven patients presented dysuria after surgery,5 cases recovered urination with 10 days,1 case recovered with 1 months,and 1 case with 6 months by bladder drainage.Eleven cases with discomfort urination and 3 cases with slow urination were found.Conclusions The modified Prolift pelvic reconstructive surgery was safe and efficacy intervention in treatment of POP and prevention of SUI.

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作者: 马宁 [1] 王凤玫 [1] 黄惠娟 [1] 宋岩峰 [1]
期刊: 《中华妇产科杂志》2012年47卷7期 505-509页 MEDLINEISTICPKUCSCDCA
分类号: R694.54
栏目名称: 盆底功能障碍性疾病
DOI: 10.3760/cma.j.issn.0529-567x.2012.07.007
发布时间: 2012-11-01
基金项目:
福建省科技创新平台建设项目
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