论文部分内容阅读
目的:探讨Prolift盆底重建术后复发的处理方法。方法:回顾分析我科目前收治的Prolift盆底重建术后复发患者的临床资料,以盆腔器官脱垂定量分期法为指标评价解剖学疗效,用生活质量问卷及性生活问卷为指标评价功能学疗效。结果:复发病例中1例未保留子宫的Prolift盆底重建者术后2年复发,目前放置子宫托疗效满意。4例保留子宫的Prolift盆底重建术后患者短期内(2～6月)复发,且均发生宫颈延长,经子宫切除术结合阴道顶端坐骨棘筋膜固定术后,3例解剖恢复良好,问卷评分示生活质量显著提高,1例因再次复发而行阴道封闭术。2例存在明显的网片侵蚀及症状性皱缩,分次剪除配合局部雌激素后治愈。结论:Prolift盆底重建术后复发病例的进一步处理目前处于初步探索阶段。子宫托保守治疗可作为首选。手术治疗建议切除存在宫颈延长的子宫结合阴道顶端固定术。坐骨棘筋膜固定术是操作简便、费用低廉的顶端固定术式,初步临床结局尚可,远期疗效有待进一步观察。经上述处理再复发者建议行阴道封闭术。
Objective: To investigate the treatment of recurrence after Prolift pelvic floor reconstruction. Methods: Retrospectively analyzed the clinical data of Prolift pelvic floor reconstruction postoperative recurrence in our department, evaluated the anatomical curative effect by using pelvic organ prolapse quantitative staging method as an index, and evaluated the functional efficacy by using quality of life questionnaire and sexual life questionnaire . Results: One case of recurrent pelvic prostheses who had not retained the uterus relapsed two years after operation, and the current placement of pessary was satisfactory. In 4 cases of Prolift pelvic reconstruction after uterine reconstruction, the patients recurred within a short period of time (2-6 months) and all had cervical extension. After hysterectomy and vaginal top ischial spine fascioplasty, 3 cases recovered well and the questionnaire The scores showed a significant improvement in quality of life, and one case had vaginal occlusion because of recurrence. 2 cases of obvious erosion and symptoms of mesh contraction, grading cut with local estrogen and cure. Conclusion: The further treatment of recurrent cases after Prolift pelvic floor reconstruction is currently at a preliminary exploration stage. Pessary conservative treatment can be preferred. Surgical treatment of the proposed removal of the existence of cervical uterine extension combined with vaginal apical fixation. Ischial spine fascia fixation is easy to operate, inexpensive top fixation, the initial clinical outcome is acceptable, long-term efficacy needs further observation. After the above-mentioned treatment of relapse who suggested vaginal closure.