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目的:评价使用网片的全盆底重建术用于Ⅲ~Ⅳ度盆腔器官脱垂(POP)的疗效及安全性。方法:对12例Ⅲ~Ⅳ度POP患者施行全盆底重建术,评估其主、客观疗效及并发症发生率。结果:平均手术时间为(116±32)min;术中失血量为(138±71)mL;留置尿管时间为(3.2±3.4)d;术后残余尿量为(38±28)mL;术后住院日为(10.0±3.6)d;平均住院费用为(35 312±6 737)元。所有患者平均随访时间22.4月(12~33个月)。主、客观治愈率均为92%(11/12);术后POP-Q分度均较术前明显改善(P<0.05);术后1年的PFIQ-7评分及PFDI-20评分均较术前评分显著降低(P<0.05)。两组术前、术后1年的PISQ评分无显著性差异(P均>0.05)。术中膀胱损伤1例、术后疼痛2例,于术后半年自然缓解。术后3个月网片外露2例,均保守治疗成功。术后1年阴道前壁脱垂复发1例,需再次入院行顶端悬吊术,无新发尿失禁。结论:使用生物网片全盆底重建术是治疗POP的有效术式;但有较高的网片外露及术后疼痛发生率,临床应用需谨慎,更适用于老年,性生活少的Ⅲ~Ⅳ度POP及穹隆脱垂患者。
Objective: To evaluate the efficacy and safety of whole pelvic floor reconstruction using mesh in the treatment of pelvic organ prolapse (Ⅲ ~ Ⅳ). Methods: Total pelvic floor reconstruction was performed in 12 patients with grade Ⅲ ~ Ⅳ POP. The main and objective curative effects and complication rates were evaluated. Results The average operation time was (116 ± 32) min. The intraoperative blood loss was (138 ± 71) mL. The duration of indwelling catheter was (3.2 ± 3.4) d. The postoperative residual urine volume was (38 ± 28) mL. The postoperative hospital stay was (10.0 ± 3.6) days and the average hospitalization cost was (35 312 ± 6 737) yuan. All patients were followed up for an average of 22.4 months (12-33 months). The objective and objective cure rates were 92% (11/12). The postoperative POP-Q index was significantly improved compared with that before operation (P <0.05). The PFIQ-7 score and PFDI-20 score at 1 year Preoperative score was significantly lower (P <0.05). There was no significant difference in PISQ score between preoperative and postoperative one year (P> 0.05). One case of intraoperative bladder injury, postoperative pain in 2 cases, 6 months after the natural relief. 3 months after mesh exposed 2 cases were conservative treatment success. One case had anterior vaginal prolapse recurrence 1 year after operation. The patient should be admitted to the top of the hospital again without any incontinence. Conclusion: The use of bio-pelvic floor reconstruction is an effective surgical treatment of POP; but there is a higher incidence of mesh exposed and postoperative pain, clinical application should be cautious, more suitable for the elderly, less sexual life Ⅲ ~ Ⅳ degree POP and dome prolapse patients.