[1]鲍春玉,李小钊,应小燕*.子宫脱垂手术是否联合生物补片治疗的临床疗效差异分析[J].中国微创外科杂志,2017,17(5):415-457.
 Bao Chunyu,Li Xiaozhao,Ying Xiaoyan..Clinical Effects of Surgical Repair with or Without Biological Mesh on Uterine Prolapse[J].Chinese Journal of Minimally Invasive Surgery,2017,17(5):415-457.
点击复制

子宫脱垂手术是否联合生物补片治疗的临床疗效差异分析()
分享到:

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年5期
页码:
415-457
栏目:
临床研究
出版日期:
2017-07-14

文章信息/Info

Title:
Clinical Effects of Surgical Repair with or Without Biological Mesh on Uterine Prolapse
作者:
鲍春玉李小钊应小燕*
南京医科大学第二附属医院妇产科,南京210011
Author(s):
Bao Chunyu Li Xiaozhao Ying Xiaoyan.
Department of Obstetrics and Gynecology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
关键词:
子宫脱垂阴式子宫切除术阴道前后壁修补术生物补片
Keywords:
Pelvic organ prolapseVaginal hysterectomyAnterior-posterior wall colporrhaphyBiological mesh
文献标志码:
A
摘要:
目的探讨生物补片联合阴式全子宫切除术+阴道前后壁修补术治疗子宫脱垂的临床效果。方法回顾性分析2010年1月~2015年5月我院106例子宫脱垂行阴式全子宫切除术+阴道前后壁修补术,其中联合生物补片治疗75例(实验组),单纯手术31例(对照组),比较2组手术时间、术中出血量、术后排气时间、术后住院时间和术后疗效。结果2组手术均顺利完成,对照组和实验组手术时间分别(91.4±3.4)、(95.1±10.2)min,无统计学差异(t=-1.970,P=0.051);出血量分别(34.5±7.3)、(32.1±4.9)ml,无统计学差异(t=1.973,P=0.051);术后排气时间分别(29.2±4.8)、(30.2±53)d,无统计学差异(t=-0.907,P=0.366);术后住院时间分别(6.1±1.5)、(6.0±1.4)d,无统计学差异(t=0.328,P=0744)。术后1年实验组治愈74例,好转1例,无复发,对照组治愈27例,好转1例,复发3例,实验组症状改善有效率明显高于对照组(Z=-2.571,P=0.010)。结论子宫脱垂患者如无需保留子宫,在无禁忌的情况下首选生物补片联合阴式子宫切除+阴道前后壁修补术,疗效好,复发率低。
Abstract:
ObjectiveTo analyze the different clinical effects of colpohysterectomy combined with anterior and posterior wall colporrhaphy with or without biological mesh for uterine prolapse.MethodsFrom January 2010 to May 2015, colpohysterectomy combined with anterior and posterior wall colporrhaphy was performed in 106 cases of uterine prolapse, including 75 cases receiving biological mesh repair (experimental group) and 31 cases of non-biological mesh (control group). Clinical and surgical information of all patients was collected, and satistial analysis was done between the two groups. ResultsAll the operations were accomplished successfully. There were no statistical differences in bleeding amount during operation [(34.5±7.3) ml vs. (32.1±4.9) ml, t=1973, P=0051], time to first flatus [(29.2±4.8) d vs. (30.2±5.3) d, t=-0.907, P=0.366], postoperative hospital stay [(6.1±1.5) d vs. (6.0±1.4) d, t=0.328, P=0.744], as well as the operative time [(91.4±3.4) min vs. (95.1±10.2) min, t=-1.970, P=0.051]. At one year after surgery, in the experimental group there were 74 patients cured, 1 patient improved, and no invalid or recurrence case, while in the control group there were 27 patients cured, 1 patient improved, 3 cases of recurrence and no invalid case. The treatment effect of the experimental group was significant better than that of the control group (Z=-2.571, P=0.010).ConclusionsColpohysterectomy with anterior and posterior wall colporrhaphy with biological mesh can be selected for uterine prolapse patients without contraindications. The results of surgery are better with biological mesh, with low recurrence rate.

参考文献/References:

[1]Gomelsky A, Rudy DC, Dmochowski RR. Porcine dermis interposition graft for repair of high grade anterior compartment defects with or without concomitant pelvic organ prolapse procedures. Urology,2004,4171(4):1581-1584.
[2]Bump RC, Mattiasson A, B K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol,1996,175(1):10-17.
[3]单丽芳,范作升.阴式与经腹子宫切除术的临床比较.中国微创外科杂志, 2004,4(2):108-109.
[4]Sanses TV,Shahryarinejad A,Molden S,et al. Anatomic outcomes of vaginal mesh procedure (Prolift) compared with uterosacral ligament suspension and abdominal sacrocolpopexy for pelvic organ prolapses: a Fellows’Pelvic Research Network study.Am J Obstet Gynecol,2009, 201(5):519e1-e8.
[5]赵英,鲁永鲜,王文英.生物源性补片用于子宫脱垂重建术的可行性研究.实用临床医药杂志,2016,20(3):69-71.
[6]张斯由,崔颖,申桂华,等.生物补片在女性前盆腔器官重建手术中作用的临床研究.中华老年医学杂志,2014,33(5):499-502.
[7]刘继娟, 李坚, 马乐.补片及其在盆腔器官膨出修补手术中的应用现状.中华妇幼临床医学杂志 (电子版),2007,3(4):230-233.
[8]Clavé A, Yahi H, Hammou JC, et al. Polypropylene as a reinforcement in pelvic surgery is not inert: comparative analysis of 100 explants. Int Urogynecol J,2010,21(3):261-270.
[9]Culligan PJ, Littman PM, Salamon CG,et al. valuation of a transvaginal mesh delivery system for the correction of pelvic organ prolapse: subjective and objective findings at least 1 year after surgery. Am J Obstet Gynecol,2010,203(5):506.e1-e6.
[10]孙智晶,朱兰,郎景和,等.“协和”全盆底重建术治疗重度盆腔器官脱垂的多中心前瞻性研究.中华妇产科杂志,2011,46(8):227-229.
[11]陈仕学,廖少明,李伟明.微创无张力腹膜前间隙衬入Kugel补片在疝修补术中的应用.实用医学杂志,2007,23(4):551-552.
[12]陈玉喜,陈德烽.血氧饱和度监测下无菌手套加涤纶补片分期治疗巨大腹裂.实用医学杂志,2005,21(20):2229.
[13]杨翔,童晓文,李怀芳,等.生物源性材料在女性盆底重建中的作用.中国组织工程研究与临床康复,2011,15(29):5475-5478.
[14]Ge L, Li Q, Jiang J, et al. Integration of nondegradable polystyrene and degradable gelatin in a core-sheath nanofibrous patch for pelvic reconstruction. Int J Nanomed,2015,24(10):3193-3201.
[15]Dell JR, O′Kelley KR. PelviSoft BioMesh augmentation of rectocele repair: the initial clinical experience in 35 patients. Int Urogynecol J Pelvic Floor Dysfunct,2005,16(1):44-47.
[16]Rice RD, Ayubi FS, Shaub ZJ, et al. Comparison of Surgisis, AlloDerm, and Vicryl Woven Mesh grafts for abdominal wall defect repair in an animal model. Aesthetic Plast Surg,2010,34(3):290-296.
[17]Trabuco EC, Zobitz ME, Klingele CJ, et al. Effect of host response (incorporation,encapsulation,mixed incorporation and encapsulation, or resorption) on the tensile strength of graft-reinforced repair in the rat ventral hernia model. Am J Obstet Gynecol,2007,197(6):638.e1-e6.
[18]郎景和.妇科泌尿学与盆底重建外科发展.中国微创外科杂志,2006,6(4):245-247.

备注/Memo

备注/Memo:
*通讯作者,E-mail:xiaoyanying@yahoo.com
更新日期/Last Update: 2017-07-14