目的 比较使用TiLOOP网片的协和式前盆底重建术与自体组织修复术的临床疗效及对患者生活质量的影响.方法 盆腔器官脱垂(POP)62例患者,随机分为TiLOOP网片组32例,自体组织修复组30例,比较两组围术期参数、临床疗效及生活质量的影响.结果 两组围术期参数中的手术时间及出血量比较差异有统计学意义(P<0.05),术后两组前中盆腔相关的Ba、Bp、C点值及生活质量问卷评分较术前均显著改善(P<0.05,P<0.001),术后两组盆底功能障碍问卷(PFDI-20)、盆镀功能影响问卷(PFIQ-7)评分比较差异有统计学意义(P<0.05).结论 使用TiLOOP网片可提高经阴道前盆腔重建手术成功率,表明TiLOOP网片在植入盆底修复POP方面是安全有效的.

目的 探讨宫颈环形电切术(LEEP)治疗宫颈鳞癌Ⅰa1期的可行性和安全性.方法 行宫颈LEEP术后病理诊断为宫颈鳞癌Ⅰa1期患者78例,接受经阴道根治性宫颈切除或全子宫切除术,结合其临床病理特征,分析LEEP术后病灶残留相关因素.结果 78例患者中,36例行经阴道根治性宫颈切除,42例行全子宫切除术.术后病理结果提示有病灶残留11例,残留率14.10％.其中,宫颈鳞状上皮不典型增生(CIN)Ⅱ级2例,CINⅢ级6例,早期癌3例.切缘阳性组患者病灶残留率22.86％(8/35),高于切缘阴性组的6.98％(3/43) (P＜0.05).年龄≤45岁的宫颈病灶残留率21.43％(9/42),高于年龄＞45岁者的5.56％ (2/36)(P＜0.05).患者的宫颈细胞学结果、宫颈活组织病理检查和高危型HPV等与LEEP术后病灶残留均无明显相关性(P＞0.05).结论 LEEP术后切缘阳性是影响宫颈病灶残留的独立危险因素,需要密切阴道镜随访,或选择再次行LEEP治疗.

目的 探讨运用GYNECARE PROSIMATM盆底修复系统进行盆底重建患者的综合护理措施,以期提高患者生活质量.方法 对29例盆腔器官脱垂程度为Ⅱ、Ⅲ度且运用GYNECAREPROSIMATM盆底修复系统进行盆底重建患者进行术前、术后的心理护理、专科护理、会阴护理及术后随访、健康指导.结果 29例患者均痊愈出院.结论 加强术前、术后护理对运用GYNECAREPROSIMATM盆底修复系统进行盆底重建患者的尽早康复至关重要。

Objective To evaluate the outcomes of treating moderate pelvic organ prolapse with PROSIMA pelvic floor repaire system. Methods Reconstruction of pelvic floor was performed using PROSIMA pelvic floor repair system in 30 patients with moderate pelvic organ prolapse.The outcomes were evaluated by POP-Q and PFIQ-7 in 6 months after operation. Results According to POP-Q,30 patients were cured.Vaginal mesh erosion was discovered in two patients(6.67%) during postoperative follow-up.The VSD was taken out on the 21st day after operation and vaginal secretions cultures showed Escherichia coli positive in 6 cases,smooth Candida positive in 1 case,and Proteus mirabilis positive in 1 case. Sexual life was satisfactory after surgery. Conclusion Reconstruction of pelvic floor with PROSIMA pelvic floor repair system is safe and effective in the patients with moderate pelvic organ prolapse,but vaginal infection is worthy of attention.

Objective:To assess the clinical efficacy of modified pelvic floor reconstruction using polypropylene mesh. Methods:162 patients with anterior vaginal wall prolapse (AVWP) of stage Ⅱor greater which were clarified by the Pelvic Organ Prolapse Quantification (POP-Q) were treated by modified pelvic floor reconstruction.The subjective and objective parameters of them were evaluated.Results:In 162 patients, the mean operation time was 97.2 min (50 to 170 min), the mean amount of blooding was 86.3 ml (120 to 300 ml). After operation,the mean maximum temperature was 37.9℃(37.2 to 39.0℃). The mean hospitalization time was 6.2 days (5 to 10 days). The average catheter retention time was 3.2 days (2 to 10 days), of which 7 cases had residual urine more than 100ml. After treatment, all of them were recovered. The average follow-up time was 18 months. Consulted with POP-Q, the objective cure rate was 97.1%, the vaginal mesh erosion rate was 3.6% (5/140) and the emerging urge incontinence rates were 3.6% (5/140).Results:Modified pelvic floor reconstruction can improve anatomical and functional recovery of bladder. It is a safe and effective surgical mode to treat vaginal wall prolapse.

目的比较两种盆底重建术的疗效。方法将盆腔脏器脱垂Ⅱ~Ⅳ度102例患者,随机分为改良盆底重建组60例,Prolift组42例,比较两组手术并发症及术后疗效。结果改良盆底重建组手术时间、出血量小于Prolift组,差异有统计学意义(P<0.05)。改良盆底重建组及Prolift组术后脱垂复发率分别为3.33%、4.76%,网片侵蚀发生率分别为3.33%、7.14%。结论两种盆底重建术均是治疗中重度盆腔脏器脱垂的有效方法。

:盆腔器官脱垂是一种中老年妇女常见的手术率、复发率较高的疾病。近年许多临床及基础研究证实盆底支持结构中结缔组织薄弱是盆腔器官脱垂发生的病理基础。弹性纤维是盆底结缔组织的重要组成成分,赋予组织伸缩性和可逆的变形能力,维持盆底结缔组织正常结构和功能。其组成、降解稳态平衡破坏,会影响弹性纤维数量及质量,减弱盆底结缔组织的支持力,使盆底组织松弛发生器官脱垂。本文主要从弹性纤维组成过程中Fibulin-5及类赖氨酰氧化酶1(LOXL-1)等相关成分异常在女性盆腔器官脱垂发病机制中的研究做一综述。

Objective:To evaluate bladder anatomical and functional recovery after modified anterior pelvic floor reconstructive surgery for bladder prolapse Ⅲ-Ⅳ degrees.Methods:Modified anterior pelvic floor reconstruction were performed in 119 patients with bladder prolapse Ⅲ-Ⅳ degrees.Patients with SUI(stress urinary incontinence)or MUI(mixed urinary incontinence)were simultanously treated with TVT-O.According to POP-Q(pelvic organ prolapse quantitation),POPDI-6(pelvic organ prolapse distress inventory 6)and UDI-6(urinary distress inventory 6),we evaluated bladder anatomical and functional recovery before and after surgery,and analyzed surgical complications.Lower urinary tract symptoms and vaginal wound healing were compared in patients treated with and without hormone therapy(HT)after surgery.Results:After the follow-up of 0.5,1 and 2 years,the objective cure rates in restoration of anatomic structure were respectively 100%,95.06% and 93.75%.Single voided volume increased(P0.05).Leakage of urine,frequent urination,urgency symptoms were improved,with improvement rates of 91.4%,92% and 100%.Urinary symptom improvement rates in patients receiving and not receiving HT were 100% and 78.9%.Conclusion:Modified anterior pelvic floor reconstruction can help to improve anatomical and functional recovery of bladder.After surgery,HT can improve lower urinary tract symptoms and vaginal wound healing.