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目的探讨应用聚丙烯网片在保留子宫的同时进行盆底重建的可行性和有效性。方法对同济大学附属同济医院妇产科2005年3月至2007年2月收治的66例有不同缺陷的女性盆腔器官脱垂患者应用聚丙烯网片进行全盆底悬吊,具体包括:采用聚丙烯网片悬吊双侧子宫主韧带、骶韧带,并将网片置入膀胱阴道筋膜和直肠阴道筋膜,同时进行肛提肌及会阴体的修复从而完成盆底3个平面的重建。合并有压力性或混合尿失禁的患者同时行尿道中段无张力悬吊术。结果手术时间平均为95min,出血量平均为120mL,根据POP-Q分度法,66例患者的子宫脱垂、阴道前后壁膨出等症状全部得到纠正,术后无院内感染发生,未观察到其它与手术相关的并发症。术后随访平均11个月,患者的盆底结构基本正常,相关症状消失或明显改善。结论应用聚丙烯网片进行全盆底悬吊是一种微创而又经济的盆底重建术,该手术在保留子宫的同时能完成全盆底结构和功能的全部或部分重建。中、短期疗效稳定,长期疗效有待进一步观察。
Objective To investigate the feasibility and effectiveness of using polypropylene mesh to preserve the uterus while pelvic floor reconstruction. Methods A total of 66 cases of pelvic organ prolapse patients with different defects admitted to Tongji Hospital Affiliated to Tongji University from March 2005 to February 2007 were treated with polypropylene mesh for whole pelvic floor suspension, Propylene mesh suspension of the main bilateral uterine ligament, sacral ligament, and the mesh into the vesicovaginal fascia and rectovaginal fascia, while the levator ani muscle and perineal body repair to complete pelvic floor reconstruction of three planes. Patients with stress or mixed urinary incontinence also performed a tension-free mid-urethral suspension. Results The mean operation time was 95 min and the average amount of bleeding was 120 mL. According to the POP-Q indexing method, 66 cases of uterine prolapse and vaginal anterior and posterior wall bulging were all corrected. No postoperative nosocomial infection was found and no bleeding was observed Other surgery-related complications. After an average follow-up of 11 months, the pelvic floor of patients with normal structure, related symptoms disappeared or significantly improved. Conclusion The use of polypropylene mesh for pelvic floor suspension is a minimally invasive and economical pelvic floor reconstruction that retains the uterus and completes all or partial reconstruction of the entire pelvic floor structure and function. In the short-term efficacy and stability, long-term efficacy remains to be further observed.