摘要
目的分析盆底修复手术后复发患者的再治疗方法及疗效。方法回顾性分析2011年1月至2016年1月在不同医院行盆底修复手术后复发（Ⅱ度及以上）而就诊于解放军福州总医院的81例患者的临床资料，探讨再治疗的方法及效果。采用盆腔器官脱垂定量分度法（POP-Q）评价客观的解剖学疗效，以盆底不适调查表简表（PFDI-20）和盆底功能影响问卷简表（PFIQ-7）评价主观的功能学疗效（评分较术前改善视为患者主观满意）。结果81例复发患者，中位随访时间为35个月（10～69个月），再次手术治疗78例（96％，78／81），解剖学治愈率100％（78／78），主观满意度100％（78／78）；另3例（Ⅱ度脱垂）行盆底肌锻炼及盆底电刺激＋生物反馈治疗，主观满意度2／3，有1例治疗后仍自诉阴道异物感。78例再次手术患者的手术方式：经阴道植入网片（TVM）全盆腔重建术55例（包括经阴道子宫颈切除＋TVM全盆腔重建术3例），TVM前盆腔重建术2例，TVM后盆腔重建术3例，Y网骶骨固定术2例，阴道封闭术11例，经阴道子宫切除＋后穹隆成形术3例，经阴道子宫切除＋TVM后盆腔重建术2例。结论盆底修复手术后复发再治疗的选择需结合患者的特征（包括复发程度、复发部位、并发症等）进行认真评估，选择合理适宜的个体化再治疗方案，仍可达到满意的疗效。
Objective To analyze re-treatments of recurrence after the pelvic floor repair surgery. Methods The protocol and the effect of re-treatments were investigated by reviewing and analyzing the clinical data of 81 recurrent patients （grade Ⅱ and above）, who had received the pelvic floor repair surgery from January 2011 to January 2016. Pelvic organ prolapse quantitation system （POP-Q） and two questionnaires about quality of life [pelvic floor distress inventory-short form 20 （PFDI-20） and pelvic floor impact questionnaire short form （PFIQ-7）] were used to evaluate objective and subjective efficacy, respectively. Results Among 81 recurrent patients who were followed up for a median of 35 months （10- 69 months）, 78 cases （with prolapse up to grade Ⅲ or Ⅳ） were treated by surgical operation with both objective cure rate and subjective satisfaction being 100% （78/78）; 3 cases （with grade Ⅱ prolapse） were treated by pelvic floor electrical stimulation biofeedback, and 1 case among the three cases had the vaginal foreign body sensation, the subjective satisfaction was 2/3. The methods of surgical operation for the 78 recurrent patients included： total pelvic floor reconstructive surgery （55 cases; 3 of which involve traehelectomy）, anterior pelvic reconstructive surgery （2 cases）, posterior pelvic reconstructive surgery （3 cases）, Y-mesh sacral eolpopexy （2 cases）, colpocleisis （11 cases）, vaginal hysterectomy combined posterior fornix forming （3 cases）, and vaginal hysterectomy combined posterior pelvic reconstructive surgery （2 cases）. Conclusion The extent of recurrence, the recurrent site and complications must be carefully considered and evaluated for re-treatments of recurrence after pelvic floor repair surgery, and then an appropriately individualized re-treatment protocol could be designed for each of the patients.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2017年第6期374-378,共5页
Chinese Journal of Obstetrics and Gynecology
基金
国家科技支撑计划（2014BAI05B02）
关键词
盆腔器官脱垂
复发
妇科外科手术
骨盆底
再手术
Pelvic organ prolapse
Recurrence
Gynecologic surgical procedures
Pelvic floor
Reoperation
