發(fā)布時間：2018-04-03 21:46

  本文選題：盆底重建　切入點(diǎn)：盆腔器官脫垂　出處：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：隨訪分析應(yīng)用網(wǎng)片的全盆底重建手術(shù)治療盆腔器官脫垂術(shù)后1年臨床療效及患者生活質(zhì)量問卷調(diào)查報告。 方法：大連市婦產(chǎn)醫(yī)院于2010年1月至2013年1月收治根據(jù)盆腔器官脫垂POP-Q分期診斷為盆腔臟器脫垂Ⅲ~Ⅳ期同意行全盆底重建手術(shù)的患者共57例。根據(jù)患者年齡、病情、合并癥及患者意愿選擇合理術(shù)式。有13例患者同時行全子宮切除術(shù)，其中2例因同時合并附件區(qū)腫物行腹腔鏡下全子宮切除術(shù)及雙附件切除術(shù)，另11例患者行經(jīng)陰道全子宮切除術(shù)。3例患者因既往有子宮切除術(shù)史術(shù)中同時行宮頸殘端切除術(shù)。6例患者同時合并壓力性尿失禁（SUI），其中5例術(shù)中一并行經(jīng)閉孔無張力尿道中段懸吊術(shù)（TVT-O）。通過POP-Q分期系統(tǒng)評價解剖學(xué)療效；通過比較患者術(shù)前、術(shù)后盆底不適調(diào)查簡表（PFDI-20）和盆底功能影響問卷簡表（PFIQ-7）評分，評估手術(shù)對患者生命質(zhì)量的改善情況；通過比較術(shù)前術(shù)后性生活質(zhì)量問卷簡表（PISQ-12）評分，評價手術(shù)對患者性生活質(zhì)量的影響。其中PFDI-20分為三個分量表： POP困擾量表（POPDI-6）、結(jié)直腸肛門困擾量表（CARDI-8）、排尿困擾量表（UDI-6）。PFIQ-7也分為3個分量表：POP影響問卷（POPIQ-7）、結(jié)直腸肛門影響問卷（CARIQ-7）、排尿影響問卷（UIQ-7）。分別從盆腔、結(jié)直腸肛門、膀胱癥狀的改善情況評價功能及臨床癥狀恢復(fù)療效。同時分析術(shù)中術(shù)后并發(fā)癥等情況。 結(jié)果：（1）解剖療效：根據(jù)POP-Q各指示點(diǎn)術(shù)后陰道前壁2點(diǎn)Aa、Ba，后壁2點(diǎn)Ap、Bp，頂部C點(diǎn)均較術(shù)前得到顯著糾正（P＜0.05），會陰體長度pb明顯增加（P＜0.05），生殖道裂孔長度gh明顯縮短（P＜0.05），但陰道總長度tvl無明顯改變（P＞0.05）。共4例患者復(fù)發(fā)，其中1例為術(shù)后1年復(fù)發(fā)為穹窿脫垂Ⅳ期再次于我院行腹腔鏡下陰道骶骨固定術(shù)，3例復(fù)發(fā)為Ⅲ期，于門診行保守治療。（2）功能療效及性生活情況： PFDI-20、PFIQ-7評分差異有統(tǒng)計學(xué)意義（P＜0.05），手術(shù)能顯著改善患者生活質(zhì)量。PFDI-20的三個分量表POPDI-6、CARDI-8、UDI-6及PFIQ-7的三個分量表POPIQ-7、CARIQ-7、UIQ-7的評分術(shù)前術(shù)后相比，患者在盆腔、結(jié)直腸肛門、膀胱不適癥狀均得到了顯著的緩解（P＜0.05）。術(shù)后PISQ-12評分與術(shù)前相比，差異無統(tǒng)計學(xué)意義（P＞0.05），說明手術(shù)對性生活質(zhì)量無影響。(3)術(shù)中術(shù)后并發(fā)癥：本研究中有3例發(fā)生膀胱損傷，2例發(fā)生在術(shù)中，1例發(fā)生在術(shù)后，均給予充分留置導(dǎo)尿后好轉(zhuǎn)出院。術(shù)后1例出現(xiàn)網(wǎng)片感染，2例網(wǎng)片暴露，，1例出現(xiàn)盆腔痛。6例出現(xiàn)新發(fā)下尿路癥狀，尿頻4例，尿不盡1例，壓力性尿失禁1例。 結(jié)論：本研究為全盆底重建術(shù)的前瞻性研究，近期解剖治愈率為92.98%，陰道前后壁和頂端的A、B、C點(diǎn)均較術(shù)前明顯抬高，提示全盆重建術(shù)對于前、中、后三個腔室的支持都非常有效、可靠。應(yīng)用網(wǎng)片的全盆底重建術(shù)近期臨床療效肯定，患者術(shù)后生活質(zhì)量顯著提高，盆腔、結(jié)直腸肛門、膀胱不適癥狀均得到了顯著的緩解，且手術(shù)對性生活無明顯影響。但圍手術(shù)期安全、網(wǎng)片侵蝕暴露、新發(fā)下尿路癥狀等相關(guān)并發(fā)癥不容忽視。
[Abstract]:Objective: to follow up and analyze the clinical efficacy and quality of life of the patients after pelvic organ prolapse for 1 years after total pelvic floor reconstruction.
Methods: the Dalian maternity hospital from January 2010 to January 2013 according to the POP-Q staging diagnosis of pelvic organ prolapse of pelvic organ prolapse III ~ IV period agreed for pelvic reconstruction surgery of the patients were 57 cases. According to the patient's age, illness, complications and patients will choose the reasonable operation type. There were 13 patients who underwent hysterectomy at the same time, except for 2 cases with adnexal mass in laparoscopic hysterectomy and bilateral adnexectomy, the other 11 patients underwent transvaginal hysterectomy for.3 patients because of previous hysterectomy were performed at the same time excision of cervical stump.6 patients with stress urinary incontinence (SUI), including 5 cases of a parallel transobturator urethral suspension (TVT-O). The POP-Q staging system for evaluation of anatomy effect; by comparing the preoperative and postoperative pelvic discomfort survey questionnaire (PFDI-20) and basin The bottom function questionnaire (PFIQ-7) score, the improvement of operation to assess the patient's quality of life; by comparing the preoperative and postoperative quality of life questionnaire (PISQ-12) score, impact assessment of the quality of life of patients with surgery. The PFDI-20 is divided into three subscales: POP distress scale (POPDI-6), colorectal and anal distress scale (CARDI-8), urinary distress scale (UDI-6).PFIQ-7 is also divided into 3 subscales: POP Impact Questionnaire (POPIQ-7), colorectal and anal Impact Questionnaire (CARIQ-7), the effect of urination questionnaire (UIQ-7). From the pelvic, colorectal and anal, improvement of symptoms and clinical evaluation of bladder function the symptoms of the restoring effect. At the same time, analysis of intraoperative and postoperative complications.
緇撴灉錛

本文編號：1707032