腹腔鏡下應用Y型聚丙烯網片治療子宮和陰道穹窿脫垂療效觀察_《中國修復重建外科雜志》

作者：

李敏 , 馮怡辰 , 金紹艷 , 俞丹華

上海交通大學附屬第六人民醫院南院微創病區（上海，201400）;

關鍵詞：

腹腔鏡 Y型聚丙烯網片子宮脫垂陰道穹窿脫垂

DOI：

10.7507/1002-1892.20130242

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目的探討腹腔鏡下應用Y型聚丙烯網片治療子宮和陰道穹窿脫垂的療效。方法 2010年6月－2012年12月，于腹腔鏡下采用Y型聚丙烯網片行陰道、子宮-骶骨固定術治療24例子宮和陰道穹窿脫垂患者。患者年齡35～60歲，平均48.6歲。病程2～8年，平均5年。根據國際節制協會（ICS）制定的盆腔器官脫垂（pelvic organs prolapse，POP）定量（POP-Q）分度標準進行評定，其中子宮脫垂Ⅱ度16例，Ⅲ度8例；陰道脫垂Ⅰ度15例，Ⅱ度7例，Ⅲ度2例。術后定期隨訪，根據POP生活質量問卷（P-QOL）量表行主觀療效評價；根據POP-Q分度標準進行客觀治愈評價。結果患者均順利完成手術。手術時間22～68 min，平均33 min；失血量30～80 mL，平均51 mL；尿管放置時間3～7 d，平均4 d；住院時間4～9 d，平均6.8 d。24例均獲隨訪，隨訪時間3～12個月，平均9個月；其中2例隨訪時間 lt; 6 個月。患者拔出尿管后均能正常排尿，殘余尿量在正常范圍。無網片侵蝕及性生活不適，無陰道及肛門下墜感；術后3、6、12個月P-QOL量表評分均顯著優于術前，差異均有統計學意義（P lt; 0.05）；術后各時間點間比較差異無統計學意義（P gt; 0.05）。術后6個月POP-Q分度標準評價為0度19例，Ⅰ度3例，客觀治愈率91.7%（22/24，2例隨訪時間 lt; 6 個月者按復發計）。隨訪期間無復發。結論腹腔鏡下應用Y型聚丙烯網片治療子宮和陰道穹窿脫垂是一種安全、有效方法，尤其適用于要求保留子宮、對性生活要求較高的患者。

引用本文： 李敏,馮怡辰,金紹艷,俞丹華. 腹腔鏡下應用Y型聚丙烯網片治療子宮和陰道穹窿脫垂療效觀察. 中國修復重建外科雜志, 2013, 27(9): 1106-1109. doi: 10.7507/1002-1892.20130242 復制

1.	Beer M, Kuhn A. Surgical technigues for vault prolapse: a review of the literature. Eur J Obstet Gynecol Reprod Biol, 2005, 119(2): 144-155.
2.	Maher C, Baessler K, Glazener CM, et al. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn, 2008, 27(1): 3-12.
3.	Clark AL, Gregory T, Smith VJ, et al. Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary in continence. Am J Obstet Gynecol, 2003, 189(5): 1261-1267.
4.	Jo H, Kim JW, Park NH, et al. Efficacy and outcome of anterior vaginal wall repair using polypropylene mesh (Gynemesh). J Obstet Gynaecol Res, 2007, 33(5): 700-704.
5.	Deffieux X, de Tayrac R, Huel C, et al. Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18(1): 73-79.
6.	Fatton B, Amblard J, Debodinance P, et al. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift technique)—a case series multicentric study. Int Urogynecol J, 2007, 18(7): 743-752.
7.	Feiner B, Gietelink L, Maher C. Anterior vaginal mesh sacrospinous hysteropexy and posterior fascial plication for anterior compartment dominated uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct, 2010, 21(2): 203-208.
8.	Hinoul P, Ombelet WU, Burger MP, et al. A prospective study to evaluate the anatomic and functional outcome of a transobturator mesh kit (prolift anterior) for symptomatic cystocele repair. J Minim Invasive Gynecol , 2008 , 15(5): 615-620.
9.	Feiner B, Maher C. Vaginal mesh contraction definition, clinical presentation, and management. Obstet Gynecol, 2010, 115(2 Pt 1): 325-330.
10.	Wu JM, Wells EC, Hundley AF, et al. Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy. Am J Obstet Gynecol, 2006, 194(5): 1418-1422.
11.	Sung VW, Rogers RG, Schaffer JI, et al. Graft use in transvaginal pelvic organ prolapse repair: a systematic Review. Obstet Gynecol, 2008, 112(5): 1131-1142.
12.	Cespedes RD. Diagnosis and treatment of vaginal vault prolapse conditions. Urology, 2002, 60(1): 8-15.
13.	Serecchioli R, Hourcabie JA, Vianello F, et al. Laparoscopic treatment of pelvic floor defects in women of reproductive age. J Am Assoc Gynecol Laparosc, 2004, 11(3): 332-335.
14.	曾俐琴, Chou Danny, Wong Felix, 等. 腹腔鏡網片骶骨陰道固定術治療陰道穹窿脫垂. 中華婦產科雜志, 2012, 47(2): 154-157.
15.	Elliott DS, Krambeck AE, Chow GK. Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol, 2006, 176(2): 655-659.

1. Beer M, Kuhn A. Surgical technigues for vault prolapse: a review of the literature. Eur J Obstet Gynecol Reprod Biol, 2005, 119(2): 144-155.
2. Maher C, Baessler K, Glazener CM, et al. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn, 2008, 27(1): 3-12.
3. Clark AL, Gregory T, Smith VJ, et al. Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary in continence. Am J Obstet Gynecol, 2003, 189(5): 1261-1267.
4. Jo H, Kim JW, Park NH, et al. Efficacy and outcome of anterior vaginal wall repair using polypropylene mesh (Gynemesh). J Obstet Gynaecol Res, 2007, 33(5): 700-704.
5. Deffieux X, de Tayrac R, Huel C, et al. Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18(1): 73-79.
6. Fatton B, Amblard J, Debodinance P, et al. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift technique)—a case series multicentric study. Int Urogynecol J, 2007, 18(7): 743-752.
7. Feiner B, Gietelink L, Maher C. Anterior vaginal mesh sacrospinous hysteropexy and posterior fascial plication for anterior compartment dominated uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct, 2010, 21(2): 203-208.
8. Hinoul P, Ombelet WU, Burger MP, et al. A prospective study to evaluate the anatomic and functional outcome of a transobturator mesh kit (prolift anterior) for symptomatic cystocele repair. J Minim Invasive Gynecol , 2008 , 15(5): 615-620.
9. Feiner B, Maher C. Vaginal mesh contraction definition, clinical presentation, and management. Obstet Gynecol, 2010, 115(2 Pt 1): 325-330.
10. Wu JM, Wells EC, Hundley AF, et al. Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy. Am J Obstet Gynecol, 2006, 194(5): 1418-1422.
11. Sung VW, Rogers RG, Schaffer JI, et al. Graft use in transvaginal pelvic organ prolapse repair: a systematic Review. Obstet Gynecol, 2008, 112(5): 1131-1142.
12. Cespedes RD. Diagnosis and treatment of vaginal vault prolapse conditions. Urology, 2002, 60(1): 8-15.
13. Serecchioli R, Hourcabie JA, Vianello F, et al. Laparoscopic treatment of pelvic floor defects in women of reproductive age. J Am Assoc Gynecol Laparosc, 2004, 11(3): 332-335.
14. 曾俐琴, Chou Danny, Wong Felix, 等. 腹腔鏡網片骶骨陰道固定術治療陰道穹窿脫垂. 中華婦產科雜志, 2012, 47(2): 154-157.
15. Elliott DS, Krambeck AE, Chow GK. Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol, 2006, 176(2): 655-659.

《中國修復重建外科雜志》

腹腔鏡下應用Y型聚丙烯網片治療子宮和陰道穹窿脫垂療效觀察

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《中國修復重建外科雜志》

腹腔鏡下應用Y型聚丙烯網片治療子宮和陰道穹窿脫垂療效觀察

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