摘要
目的评价经阴道植入轻型钛化聚丙烯网片TiLOOP的盆底重建术的临床短期疗效和安全性。方法回顾性分析南京医科大学附属无锡妇幼保健院2017年11月至2019年7月,以阴道前壁膨出Ⅲ~Ⅳ度为主的50例盆腔器官脱垂(POP)患者,对其实施经阴道植入TiLOOP网片的盆底重建术,其中自行裁剪TiLOOP网片的“协和式”盆底重建术37例、TiLOOP Total 6套盒网片的盆底重建术13例。评价术后各项主观指标[包括患者整体印象改善评分(PGI-I)、盆底不适调查表简表(PFDI-20)、盆底功能影响问卷简表(PFIQ-7)、盆腔器官脱垂与尿失禁性生活问卷(PISQ-12)]、客观指标(包括临床疗效评定为“成功”)以及并发症的发生情况。结果50例POP患者的随访时间为(18±6)个月。手术成功率为90%(45/50),单独阴道前壁、顶端、后壁脱垂的复发率分别为2%(1/50)、2%(1/50)、6%(3/50);无一例行再次手术或子宫托治疗。PGI-I显示,50例患者均主观满意,其中明显改善者46例(92%,46/50)、有改善者4例(8%,4/50);术后3、6、12个月随访,PFDI-20及PFIQ-7评分均较术前显著下降,差异均有统计学意义(P均<0.05);PISQ-12评分术前与术后比较,差异无统计学意义(P>0.05),无新发性交痛。网片暴露率为12%(6/50),新发压力性尿失禁的发生率为4%(2/47)。结论经阴道植入TiLOOP网片的盆底重建术是一种安全、有效的手术方式,短期疗效较好,但如何减少网片暴露仍需继续探究。
Objective To evaluate the short-term clinical efficacy and safety of transvaginal pelvic floor reconstruction with TiLOOP mesh,a titanized polypropylene lightweight mesh.Methods From November 2017 to July 2019,50 patients underwent surgery,who were with anterior vaginal prolapse stageⅢ-Ⅳand(or)apical prolapse and posterior vaginal prolapse(stageⅠ-Ⅱ);37 patients underwent self-cut TiLOOP mesh and 13 patients underwent pre-cut mesh-kit procedure.The subjective and objective parameters(including surgical success)of them were evaluated.Results The mean follow-up time was(18±6)months.The overall surgical success rate was 90%(45/50).Prolapse recurrence rates were isolated anterior 2%(1/50),isolated apical 2%(1/50)and isolated posterior 6%(3/50).None of recurrent patients underwent re-treatment,including either surgery or use of a pessary at last follow-up.According to patient global impression of improvement(PGI-I),46 patients(92%,46/50)were very much better,and 4 patients(8%,4/50)were much better.After the operation,pelvic floor distress inventory-short form 20(PFDI-20)and pelvic floor impact questionnaire-short form 7(PFIQ-7)scores were significantly lower than those before operation(all P<0.05);pelvic organ prolapse-urinary incontinence sexual questionnaire 12(PISQ-12)score was no significant difference before and after operation(P>0.05),but without dyspareunia.The vaginal mesh erosion rate was 12%(6/50)and the stress urinary incontinence was observed in 2 cases(4%,2/47).Conclusion Transvaginal pelvic floor reconstruction with TiLOOP mesh is a safe and effective surgery,short-term efficacy is acceptable,how to reduce the mesh erosion still need to be explored.
作者
黄益娟
陈艳琴
李文娟
王月霞
龚健
Huang Yijuan;Chen Yanqin;Li Wenjuan;Wang Yuexia;Gong Jian(Department of Obstetrics and Gynecology,the Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University,Wuxi 214000,China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2021年第2期102-107,共6页
Chinese Journal of Obstetrics and Gynecology
基金
无锡市卫生计生委科研项目(MS201748)。
关键词
盆腔器官脱垂
骨盆底
修复外科手术
外科网
钛
聚丙烯类
Pelvic organ prolapse
Pelvic floor
Reconstructive surgical procedures
Surgical mesh
Titanium
Polypropylenes
