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目的:初步探讨聚丙烯网片在女性盆底重建手术中的近期疗效和安全性。方法:从2008年8月～2010年7月上海市长宁区妇幼保健院采用聚丙烯网片完成盆底重建手术共119例。术前按盆腔器官脱垂定量(POP-Q)分期,其中Ⅲ度以上膀胱膨出、子宫脱垂及直肠膨出分别为84例(70.6%)、64例(53.8%)、19例(16.0%),阴道穹窿膨出4例(3.4%),同时存在2个以上部位缺陷91例(76.5%)。结果:前、后盆底重建及全盆底重建术各54例、13例及52例,其中保留子宫55例(46.2%),同时行经闭孔尿道中段悬吊术65例(54.6%)。术后平均随访时间17.8个月,网片外露6例(5.0%),新发膀胱过度活动症6例(5.0%),压力性尿失禁4例(3.4%),无症状膀胱Ⅱ度膨出3例(2.5%)。术后6月前盆底重建组Aa及C点值,后盆底重建组Ap及C点值,全盆底重建组Aa、Ap及C点值与术前比较差异均有统计学意义(P<0.05)。结论:应用聚丙烯网片的盆底重建手术是一种安全又经济的术式,可以同时治疗压力性尿失禁和保留脱垂的子宫,手术近期疗效满意,远期效果有待进一步随访观察。
Objective: To investigate the short-term efficacy and safety of polypropylene mesh in female pelvic floor reconstruction. Methods: From August 2008 to July 2010, a total of 119 cases of pelvic floor reconstruction were completed with polypropylene mesh in Shanghai Changning MCH. Preoperative pelvic organ prolapse quantitative (POP-Q) staging, of which cystocele above the third degree, uterine prolapse and rectocele were 84 cases (70.6%), 64 cases (53.8%), 19 cases %), Vaginal vault bulging in 4 cases (3.4%), while there are more than two defects in 91 cases (76.5%). Results: The anterior and posterior pelvic floor reconstruction and pelvic floor reconstruction in 54 cases, 13 cases and 52 cases, of which 55 cases were retained uterus (46.2%), while the middle of the closed via the urethra in 65 cases (54.6%). Postoperative average follow-up time was 17.8 months, in which 6 cases (5.0%) had net exposure, 6 cases (5.0%) had new overactive bladder, 4 cases (3.4%) urinary incontinence, 3 cases (2.5%). The values of Aa and C in pelvic floor reconstruction group before operation and Ap and C values in posterior pelvic floor reconstruction group were significantly different from those in preoperative pelvic floor reconstruction group (P <0.05). CONCLUSION: Pelvic floor reconstruction with polypropylene mesh is a safe and economical procedure for stress urinary incontinence and retention of the prolapsed uterus. The short-term curative effect is satisfactory and the long-term effect needs further follow-up.