本文選題：網(wǎng)片 + 盆底重建手術(shù)　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討導(dǎo)致使用網(wǎng)片盆底手術(shù)重建術(shù)后復(fù)發(fā)的相關(guān)因素、防范措施及復(fù)發(fā)后的治療,以指導(dǎo)臨床工作。方法:回顧性分析大連醫(yī)科大學(xué)附屬大連市婦產(chǎn)醫(yī)院婦科2008年3月至2016年11月使用網(wǎng)片行盆底重建手術(shù)治療的復(fù)發(fā)性女性盆底功能障礙性疾病行二次手術(shù)的7例患者臨床資料。結(jié)果:7例病例中,病程5～12年,平均(8.6±2.37)年,隨訪時(shí)間30～108個(gè)月,平均(78.4± 29)個(gè)月,第一次手術(shù)年齡57～73歲,平均(62 ±5.7)歲,第二次手術(shù)年齡58～75歲,平均(64.6±6.1)歲,復(fù)發(fā)相關(guān)高危因素:均為老年絕經(jīng)女性,絕經(jīng)年齡41～57歲,平均(49±5.4)歲,絕經(jīng)時(shí)間3～25年,平均(13±9.1)年,均未行激素替代治療;孕次1～4次,平均(3.3±1.1)次,產(chǎn)次1～3次,平均(1.6±0.8)次,均為陰道分娩。便秘42.9%(3/7),陰道內(nèi)均有壓迫感,高血壓71.4%(5/7),糖尿病28.6%(2/7),壓力性尿失禁(Stress Urinary Incontinence,SUI)57.1%(4/7),重癥肌無力 14.3%(1/7),臍疝 14.3%(1/7)。病例一首次行陰式全子宮切除術(shù)+加用網(wǎng)片的陰道前壁修補(bǔ)術(shù)+陰道后壁傳統(tǒng)修補(bǔ)術(shù),術(shù)后7個(gè)月復(fù)發(fā),術(shù)后8個(gè)月因陰道后壁脫垂復(fù)發(fā)后行加用網(wǎng)片的陰道后壁修補(bǔ)術(shù);病例二首次行保留子宮的Prolift全盆底重建術(shù)+無張力尿道吊帶術(shù)一閉孔系統(tǒng)(tension—free vaginal tape—obturator,TVT-O),術(shù)后 38 個(gè)月復(fù)發(fā),術(shù)后 44個(gè)月因子宮脫垂復(fù)發(fā)行腹腔鏡下全子宮切除+雙側(cè)附件切除術(shù)+加用網(wǎng)片的陰道骶前固定術(shù);病例三曾行全子宮切除術(shù),首次行全盆底重建術(shù),術(shù)后2個(gè)月復(fù)發(fā),術(shù)后12個(gè)月因陰道穹隆脫垂復(fù)發(fā)行疝囊高位結(jié)扎術(shù)+前盆重建術(shù);病例四首次行加用補(bǔ)片的陰道前壁修補(bǔ)術(shù),術(shù)后即復(fù)發(fā)SUI,術(shù)后24個(gè)月行TVT-O;病例五首次行加用補(bǔ)片的陰道前壁修補(bǔ)術(shù)+TVT-O,術(shù)后18個(gè)月復(fù)發(fā),術(shù)后24個(gè)月因子宮脫垂復(fù)發(fā)行陰式全子宮切除術(shù);病例六首次行加用補(bǔ)片的陰道前壁修補(bǔ)術(shù),術(shù)后49個(gè)月復(fù)發(fā),術(shù)后51個(gè)月因子宮及陰道后壁脫垂復(fù)發(fā)行陰式全子宮切除術(shù);病例七首次行保留子宮的全盆重建術(shù),術(shù)后6個(gè)月復(fù)發(fā),術(shù)后54個(gè)月因子宮及陰道前壁脫垂復(fù)發(fā)行陰式全子宮切除術(shù)+傳統(tǒng)陰道前壁修補(bǔ)術(shù);兩次手術(shù)后均取得了滿意的效果。結(jié)論:本組資料中使用網(wǎng)片行盆底重建手術(shù)后復(fù)發(fā)行二次手術(shù)的發(fā)生率1.7%。年齡大、經(jīng)陰道分娩、產(chǎn)次、絕經(jīng)、術(shù)前脫垂程度高、合并內(nèi)科合并癥、便秘、術(shù)前評(píng)估不充分、術(shù)式選擇不正確、術(shù)者手術(shù)操作不到位、網(wǎng)片放置及固定的位置欠缺等是術(shù)后復(fù)發(fā)高危因素。復(fù)發(fā)后手術(shù)方式的選擇應(yīng)從多方面進(jìn)行考量,只有制定出適合的個(gè)體化治療方案才能達(dá)到最佳的治療效果。
[Abstract]:Objective: to explore the related factors, preventive measures and treatment of postoperative recurrence after pelvic floor reconstruction with mesh for guiding clinical work. Methods: the clinical data of 7 patients with recurrent female pelvic floor dysfunction who underwent pelvic floor reconstruction from March 2008 to November 2016 were retrospectively analyzed in Department of Gynecology and Gynecology of Dalian Municipal Gynecology Hospital affiliated to Dalian Medical University. Results among the 7 cases, the course of disease ranged from 5 to 12 years, with an average of 8.6 鹵2.37 years. The follow-up period was 30 ~ 108 months, with an average of 78.4 鹵29 months. The age of the first operation was 5773 years (mean 62 鹵5.7) years, and the age of the second operation was 5875 years with an average of 64.6 鹵6.1 years. The high risk factors of recurrence were all elderly menopausal women, the menopausal age was 41 ~ 57 years (mean 49 鹵5.4) years, the menopausal time ranged from 3 to 25 years, the average time was 13 鹵9.1 years, the number of pregnancies was 4 times (mean 3.3 鹵1.1), the average number of births was 1.3 times (1.6 鹵0.8). All were vaginal parturition. Constipation 42.9% / 7, vaginal pressure was felt, hypertension 71.4%, diabetes 28.620 / 7, stress Urinary incontinence 57.1%, myasthenia gravis 14.33% 7 / 7, umbilical hernia 14.33% 1 / 7, umbilical hernia 14.33% 7 / 7, and stress Urinary incontinence 57.1% 7 / 7, stress incontinence 57.1%, myasthenia gravis 14.33% 7 / 7, umbilical hernia 14.33% 1 / 7, stress Urinary incontinence 57.1% 7 / 7, myasthenia gravis 14.33 / 7, umbilical hernia 14.33 / 7. The first case was treated with vaginal anterior wall repair by vaginal hysterectomy and mesh for the first time. The posterior wall of vagina recurred 7 months after operation and 8 months after the posterior wall prolapse of vagina, the posterior wall of vagina was repaired with mesh. In case 2, Prolift total pelvic floor reconstruction with uterine preservation was performed for the first time. The tension-free vaginal tape-obturator TVT-OG system was performed without tension urethral sling. It recurred 38 months after operation. The vaginal presacral fixation was performed 44 months after hysterectomy due to uterine prolapse, total hysterectomy by laparoscope with bilateral appendage hysterectomy with mesh, total hysterectomy with total pelvic floor reconstruction for the first time, and recurrence 2 months after operation. 12 months after operation, the herniation sac was reissued for the vaginal fornix, and the anterior vaginal wall was repaired with patch for the first time in case 4, the anterior pelvic reconstruction was performed with high ligation of hernia sac. In case 5, TVT-O was performed for the first time and the vaginal anterior wall was repaired with patch for the first time. It recurred at 18 months after operation, and the vaginal hysterectomy was released 24 months after operation because of uterine prolapse. In case 6, vaginal anterior wall was repaired with patch for the first time, and relapsed after 49 months. Vaginal hysterectomy was released 51 months after operation due to prolapse of the uterus and posterior wall of vagina. In case 7, hysterectomy was performed for the first time. It recurred at 6 months after operation. After 54 months of operation, vaginal hysterectomy was performed with vaginal anterior wall repair due to prolapse of uterus and anterior wall of vagina, and satisfactory results were obtained after both operations. Conclusion: the incidence of recurrence after pelvic floor reconstruction was 1.7%. Age, vaginal delivery, labor, menopause, high degree of prolapse before operation, complication of internal medicine, constipation, inadequate preoperative evaluation, incorrect choice of operation, improper operation of the operator, Mesh placement and lack of fixed position are high risk factors for postoperative recurrence. The choice of operation mode after recurrence should be considered from many aspects, and the best treatment effect can be achieved only by formulating suitable individualized treatment plan.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R713

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本文編號(hào)：1866519