摘要
目的初步探讨补片(mesh)在女性盆腔脏器脱垂手术重建盆底功能中的应用情况。方法我院妇科2004年3月～2005年4月期间共有18名患者因盆腔器官脱垂应用补片(mesh)进行盆底修补和重建。平均年龄68.6岁(48～78岁)。阴道前壁膨出17例,子宫脱垂15例,阴道后壁膨出12例。18例患者中14例行经阴式子宫切除术,1例行开腹全子宫切除术,1例保留子宫,2例已行子宫切除手术。同时行阴道前后壁修补术17例,单行阴道后壁修补术1例。单独置入阴道前壁补片11例,同时置入阴道前壁和后壁补片6例,单独置入阴道后壁补片1例。2例术中同时行阴道穹隆骶棘韧带悬吊术,4例术中行后路吊带阴道穹隆骶骨固定术。结果18例患者总手术时间平均为116.2min(85～150min),其中放置补片的时间平均15min。术中出血平均176ml(100～300ml)。术后恢复良好,术后住院时间5.4d(5～9d)。平均随访13.1个月(6～19个月),发现4例补片侵蚀阴道黏膜,发生率为22.2%,其中1例为前壁补片,此补片较大,为梯形补片,大小为5cm×12cm;3例为后壁补片。无补片感染发生。3例(16.7%)患者出现脏器膨出复发,1例阴道前壁膨出复发Ⅲ期,1例阴道前壁膨出复发Ⅰ期,1例阴道后壁膨出复发Ⅰ期。结论补片在女性盆底重建手术中的应用,方法简单,操作容易,不延长手术时间,患者耐受性好,但补片放置方法有待进一步探讨。
Objective To investigate the application of mesh in female pelvic reconstruction surgery. Methods Eighteen patients were underwent the operation for pelvic organ prolapse who were admitted from Mareh 2004 to April 2005 in our department. Mesh was used for pelvic floor reconstruction in the operation. The average age was 68.6 （48 - 78） years. The patients with the anterior vaginal wall prolapse were 17 cases, with the uterine prulapse were 15 cases, with the posterior vaginal wall prulaw, e were 12 eases. 14 patients were performed vaginal hysterectomy; 1 patient was underwent total abdominal hysterectomy ; Only 1 patient was conserved uterus. The other patient had done hystereetomy. 11 case were repaired anterior vaginal wall with mesh, 1 case was repaired the posterior vaginal wall with mesh. Both of the anterior aod posterior vaginal wall were repaired with mesh in 6 cases; Results The mean operation time was 116.2min （85 - 150 min） .The mean time of mesh placement was about 15 min only.The mean hemorrage was 176ml （ 100 - 300 ml）. All the patients were well - being after operation. The mean period of follow - up after operation was 13.1 month （6 - 19 months）. The erusion had happened in 4 cases, and its incidence was 22.2%. Among them, 1 cases was in anterior vaginal wall and 3 cases was in posterior vaginal wall. No mesh infection was found. 3 cases recurrence （16.7%） was found in the study. Among them, 2 eases were stage Ⅰ. recurrence; 1 case was stage Ⅲ recurrence. Conclusions The application of mesh in female pelvic reconstruction surgery was easy and simple. Patient tolerenee was well. Mesh erusiou is a common complication, which should be noticed. However, the long term outcome of Mesh in pelvic floor reconstruction needs further study.
出处
《中国妇产科临床杂志》
2006年第1期9-12,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
关键词
盆腔脏器膨出
补片
盆底重建手术
pelvic organ prolapse
mesh
pelvic floor reconstruction
