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陈丹妮,陈敖峥,高丹凤,等.改良型经阴道植入网片盆底重建术治疗复合型盆腔器官脱垂的临床分析[J].同济大学学报（医学版）,2021,42(6):802-808. [点击复制]
CHEN Dan-ni,CHEN Ao-zheng,GAO Dan-feng,et al.Efficacy of modified transvaginal mesh(TVM) pelvic floor reconstruction in treatment of patients with complex pelvic organ prolapse（POP）[J].同济大学学报（医学版）,2021,42(6):802-808. [点击复制]

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改良型经阴道植入网片盆底重建术治疗复合型盆腔器官脱垂的临床分析
陈丹妮,陈敖峥,高丹凤,顾卓荣,王耀玲,毛晓燕
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(上海交通大学医学院附属同仁医院妇产科，上海　200336)

摘要:

目的　评价改良型经阴道植入网片（transvaginal mesh, TVM）盆底重建术治疗60岁以上复合型盆腔器官脱垂（pelvic organ prolapse, POP）患者的效果。方法　2018年10月—2020年10月对上海交通大学医学院附属同仁医院61例60岁以上行TVM手术的复合型盆腔器官脱垂患者进行随机对照研究，其中29例行标准TVM术，32例行改良TVM术。分别记录两组患者手术时间、出血量、术前术后的POP-Q评分改善情况，统计盆底功能障碍问卷(pelvic floor distress inventory-short form 20, PFDI-20)、盆底障碍影响简易问卷-7（pelvic floor impact questionnaire-short form 7, PFIQ-7)得分。评价两组间手术时间、手术并发症，客观治愈率及主观治愈率的差异。结果　61例患者均手术顺利，对照组时间为(4597±504) min，出血量为(9022±2999) mL。改良组手术时间为(2759±819) min，出血量为(5005±1689)mL，差异有统计学意义（P<005）。合并重度压力性尿失禁(stress urinary incontinence, SUI)7例，其中对照组3例，改良组4例，予术中同时行经闭孔无张力尿道中段吊带术（transobturator tension-free vaginal tape, TVT-O）。该61例患者获得6～30个月的随访，中位随访时间16个月，两组术后POP-Q指示点（Aa,Ba,C,D,Ap,Bp)可达解剖复位(P<0001)，无手术失败，无术后复发。两组术前术后PFDI-20及PFIQ-7均有显著改善，主观治愈率为980%，客观治愈率为955%，两组间改善程度差异无统计学意义(P>005)。随访两组均未发现术后新发尿失禁及网片暴露病例。结论　改良型TVM盆底重建术用于治疗60岁以上复合型盆腔器官脱垂的患者，主、客观治愈率高。改良术式能缩短手术时间、平均住院日，降低术中出血及术后并发症的发生率,TVM手术无短期复发及网片暴露风险，但手术的远期疗效有待进一步观察。

关键词: 上海交通大学医学院附属同仁医院妇产科，上海　200336

DOI：10.12289/j.issn.1008-0932.21171

投稿时间：2021-04-30

基金项目:上海市医学重点专科(ZK2019C13);上海市长宁区医学重点专科(20191002);上海市长宁区科委课题(CNKW2018Y06)

Efficacy of modified transvaginal mesh(TVM) pelvic floor reconstruction in treatment of patients with complex pelvic organ prolapse（POP）

CHEN Dan-ni,CHEN Ao-zheng,GAO Dan-feng,GU Zhuo-rong,WANG Yao-ling,MAO Xiao-yan

(Dept. of Obstetrics and Gynecology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China)

Abstract:

Objective　To evaluate the efficacy of modified transvaginal mesh（TVM) pelvic floor reconstruction in the treatment of patients with complex pelvic organ prolapse（POP). Methods　From October 2018 to October 2020, a randomized control study was conducted in 61 patients over 60 years old with complex POP who were treated with TVM palvic floor reconstruction in Tongren Hospital, Shanghai Jiao Tong University School of Medicine. Among them, 29 patients were treated with conventional TVM procedure and 32 patients were treated with modified TVM procedure. The operation time, blood loss and pelvic organ prolapse quantification（POP-Q) scores before and after operation were compared. The pelvic floor impact questionnaire-short form 7 （PFIQ-7) and pelvic floor distress inventory-short form 20(PFDI-20) were used to evaluate objective cure rate and subjective cure rate. Results　The operation was successful in all 61 patients. The operation time was （4597±504) min in control group and （2759±819) min in modified group（P<005）. The amount of bleeding was（9022±2999) mL in control group and（5005±1689) mL in modified group（P<005）. Seven patients with severe stress urinary incontinence（SUI) were treated with transobturator tension-free vaginal tape（TVT-O), there were 3 cases in the control group and 4 cases in the modified group.The patients were followed up for 6 to 30 months, with a median follow-up time of 16 months. The POP-Q indicator points（Aa, Ba, C, D, Ap and Bp) reached anatomic reduction（P<0001). There were no failures or recurrences. The difference of PFDI-20 and PFIQ-7 before and after operation were statistically significant（P<005）. But the improvement rate between two groups was not significant. The subjective cure rate was 980%, and the objective cure rate was 955%. No new urinary incontinence and mesh exposure were found in the follow-up. Conclusion　The modified TVM has a high subjective and objective cure rate in the treatment of complex pelvic organ prolapse in patients over 60 years old. This modified operation can shorten the operation time, length of hospital stay, reduce the incidence of intraoperative bleeding and postoperative complications. There are no short-term recurrence and mesh exposure risk after TVM procedure, but the long-term effect of the operation needs to be further observed.

Key words: transvaginal mesh pelvic floor reconstruction pelvic organ prolapse modified effectiveness