本文選題：盆腔臟器脫垂 + 硅膠子宮托�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：盆腔器官脫垂(Pelvic organ prolapse,POP)是指因盆底的支持系統(tǒng)作用減弱而致使膀胱、子宮以及直腸等器官組織位置下移。隨著人類壽命的延長,盆腔器官脫垂發(fā)病率逐年上升,其終生患病率高達(dá)30%~50%,脫垂程度達(dá)III度以上將嚴(yán)重影響患者的生活質(zhì)量。目前,脫垂程度III度以上的治療方式主要包括子宮托治療以及手術(shù)治療。手術(shù)主要包括傳統(tǒng)術(shù)式及放置網(wǎng)片的盆底重建術(shù)。美國婦產(chǎn)科學(xué)會將子宮托治療POP作為其指南中推薦的首選方法,然而目前國內(nèi)硅膠子宮托只在少數(shù)三甲醫(yī)院被應(yīng)用,且重度脫垂的治療仍以手術(shù)為主。近些年,國內(nèi)已有針對硅膠子宮托治療盆腔臟器脫垂的研究,但仍缺乏針對當(dāng)前流行的盆腔臟器脫垂治療策略的對比研究。本研究通過對硅膠子宮托和盆底重建術(shù)治療老年重度POP患者的隨訪觀察對其療效進(jìn)行評估,為老年患者治療方式的選擇提供臨床依據(jù)。目的探討硅膠子宮托和盆底重建術(shù)兩種不同方式改善老年女性重度盆腔器官脫垂患者生活質(zhì)量的差異,并對治療后滿意度及并發(fā)癥進(jìn)行分析,旨在為老年P(guān)OP患者治療方式的選擇提供臨床依據(jù)。資料與方法1研究對象選取2013年1月至2014年5月就診于鄭州大學(xué)第三附屬醫(yī)院的有癥狀、年齡60歲以上、盆腔器官脫垂定量分度Ⅲ~Ⅳ度的老年患者,經(jīng)治療方式的詳細(xì)咨詢(包括硅膠子宮托和盆底重建術(shù)治療的方法、優(yōu)缺點(diǎn)、可能存在的并發(fā)癥及費(fèi)用等),排除對兩種治療均有禁忌癥的患者,按其選擇進(jìn)行分組。2研究方法2.1硅膠子宮托:均由美國COOPER公司提供,由于本研究對象均為POP-Q III-IV度,故所用類型為兼?zhèn)渲魏吞畛渥饔玫膱A形短柄狀(Gellhorn型)。2.2手術(shù):所選術(shù)式為當(dāng)前應(yīng)用較廣、適用于重度POP的子宮切除術(shù)+陰道置入網(wǎng)片的盆底重建術(shù),或單純行陰道置入網(wǎng)片的盆底重建術(shù)。手術(shù)均由我院盆底重建病區(qū)資深醫(yī)生一人進(jìn)行。2.3資料收集:包括:就診年齡、體質(zhì)指數(shù)(body mass index,BMI)、經(jīng)陰道分娩次數(shù)、激素補(bǔ)充治療情況、絕經(jīng)情況,既往是否行子宮切除術(shù)、尿失禁情況,有無慢性咳嗽病史及慢性便秘病史,有無合并糖尿病,精神類疾患等病史。2.4分組:排除禁忌癥后按患者選擇進(jìn)行分組,分為硅膠子宮托組和盆底重建術(shù)組,共144例納入本研究。2.5排除標(biāo)準(zhǔn):(1)因某種合并癥(如心、肝、肺、腎等疾病)影響麻醉或手術(shù)而只能用子宮托治療者;(2)子宮托試戴失敗或使用子宮托后又改選手術(shù)治療者;(3)合并其它婦科疾病需要手術(shù)治療者。2.6診斷標(biāo)準(zhǔn):本研究中脫垂分度所應(yīng)用的標(biāo)準(zhǔn)為盆腔器官脫垂定量分度法(pelvic organ prolapsed quantitation,POP-Q)。2.7臨床效果分析:應(yīng)用盆底功能障礙問卷PFDI-20、盆底障礙簡易調(diào)查問卷PFIQ-7對患者的治療前的生活質(zhì)量進(jìn)行評分。完善治療后6個月、2年P(guān)FDI-20、PFIQ-7評分。參照Bai等的滿意度評估方法對治療后滿意度評分。進(jìn)行組內(nèi)治療前后生活質(zhì)量評分比較,組間治療后6個月、2年的生活質(zhì)量評分及滿意度的比較,并對并發(fā)癥進(jìn)行分析。2.8隨訪及統(tǒng)計分析:主要以門診隨訪和電話隨訪為主。完善治療后6個月、2年的PFDI-20、PFIQ-7評分,詳細(xì)詢問其并發(fā)癥出現(xiàn)的時間、類型及次數(shù)。并對其滿意度進(jìn)行記錄分析。所有數(shù)據(jù)均錄入EXCEL表格。錄入的數(shù)據(jù)均使用統(tǒng)計學(xué)分析軟件SPSS21.0進(jìn)行分析比較,根據(jù)數(shù)據(jù)類型不同(定量資料、定性資料)及比較范圍不同(組內(nèi)比較、組間比較)應(yīng)用相應(yīng)的分析方法進(jìn)行統(tǒng)計學(xué)計算。檢驗(yàn)水準(zhǔn)取α=0.05,P值0.05為有統(tǒng)計學(xué)意義。結(jié)果1.硅膠子宮托與盆底重建術(shù)治療6個月和治療2年P(guān)FDI-20、PFIQ-7評分較治療前均降低(P0.05)。子宮托治療2年與6個月比較PFDI-20、PFIQ-7評分差異無統(tǒng)計學(xué)意義,其P值分別為0.43、0.75。盆底重建術(shù)治療2年與6個月比較PFDI-20、PFIQ-7評分差異有統(tǒng)計學(xué)意義,其P值分別為0.04、0.03。2.盆底重建術(shù)與硅膠子宮托治療6個月后生活質(zhì)量評分比較無明顯統(tǒng)計學(xué)差異,PFDI-20、PFIQ-7評分P值分別為0.35、0.83。3.盆底重建術(shù)2年后治療效果優(yōu)于硅膠子宮托,PFDI-20、PFIQ-7的P值分別為0.00、0.02。4.盆底重建術(shù)與子宮托治療后滿意度6個月組間差異無統(tǒng)計學(xué)意義(P=0.37);治療后2年手術(shù)組滿意度高于子宮托組,差異有統(tǒng)計學(xué)意義(P=0.04),盆底重建術(shù)治療遠(yuǎn)期滿意度較硅膠子宮托高。5.子宮托并發(fā)癥主要為:陰道分泌物增多17.02%(8/47),陰道異味10.64%(5/47)。6.盆底重建術(shù)圍手術(shù)期并發(fā)癥主要為:穿刺點(diǎn)或下肢牽拉痛13.92%(11/79),尿潴留8.86%(7/79);術(shù)后遠(yuǎn)期并發(fā)癥:網(wǎng)片外露13.92%(11/79),新發(fā)尿路癥狀10.13%(8/79)。結(jié)論1.硅膠子宮托與盆底重建術(shù)均為治療老年重度盆腔臟器脫垂的有效方法,療效確切。2.盆底重建術(shù)與硅膠子宮托治療老年重度盆腔臟器脫垂近期療效及治療后滿意度無明顯差異,但遠(yuǎn)期療效及滿意度盆底重建術(shù)較高。3.對于高齡患者而言盆底重建術(shù)圍手術(shù)期并發(fā)癥及網(wǎng)片外露發(fā)生率較高。4.高齡患者、不能耐受手術(shù)或者不接受手術(shù)治療的患者,硅膠子宮托是一種值得推薦的治療方法。
[Abstract]:Pelvic organ prolapse (POP) refers to the displacement of bladder, uterus and rectum because of the weakening of the support system of the pelvic floor. With the prolongation of human life, the incidence of pelvic organ prolapse is rising year by year, its lifetime prevalence is up to 30%~50%, and the degree of prolapse of more than III will seriously affect the patient. At present, more than III degrees of prolapse are mainly included in the treatment of uterine care and surgical treatment. The operation mainly includes the traditional surgery and the placement of the pelvic floor reconstruction. The American Society of Obstetrics and Gynecology has recommended the treatment of POP as the preferred method in its guide. However, the domestic silicone uterine care is only a few in the country. Three a hospital has been used, and the treatment of severe prolapse is still based on operation. In recent years, there has been a study on the treatment of pelvic viscera prolapse by silicone hysterectomy in recent years, but there is still a lack of comparative study on the current popular treatment strategies for pelvic viscera prolapse. This study was carried out in the treatment of elderly severe POP patients by silica gel subuterine palaces and pelvic floor reconstruction. To evaluate the curative effect of the elderly patients and provide clinical basis for the treatment of elderly patients. Objective to explore the difference in the quality of life of the elderly women with severe pelvic organ prolapse by two different ways to improve the quality of life of the elderly women with severe pelvic organ prolapse, and to analyze the degree of satisfaction and complications after the treatment. The purpose of this study is to develop the elderly patients with POP. The selection of treatment methods provided clinical basis. Data and methods 1 subjects were selected from January 2013 to May 2014 at the Third Affiliated Hospital of Zhengzhou University, the elderly patients aged 60 years and above, with the quantitative degree of pelvic organ prolapse grade III ~ IV, and the detailed and detailed counseling (including silica gel and pelvic floor reconstruction) Methods of treatment, advantages and disadvantages, possible complications and costs, excluding those with contraindications to two treatments, according to the choice of the group.2 study method 2.1 silica gel: all of which were provided by COOPER company in the United States, because the subjects of this study were all POP-Q III-IV degrees, so the type used for both support and filling of the circular short. The Gellhorn type (type).2.2 operation: the selected operation is widely used for the current application of the pelvic floor reconstruction with severe POP hysterectomy plus the vaginal insertion mesh, or the pelvic floor reconstruction with a simple vaginal insertion mesh. The operation is collected by a senior doctor in the pelvic floor reconstruction area of our hospital for a.2.3 data collection, including the age of treatment, body mass index (Bo Dy mass index, BMI), the number of vaginal delivery, hormone supplement treatment, menopause, previous hysterectomy, urinary incontinence, chronic cough history and chronic constipation history, or without diabetes, psychiatric disorders, such as the history of the.2.4 group: after exclusion of contraindications to the patients selected for grouping, divided into silicone uterine care group A total of 144 cases of pelvic floor reconstruction were included in the.2.5 exclusion criteria in this study: (1) patients who had a certain complication (such as heart, liver, lung, kidney and other diseases) could only use uterine care for anesthesia or surgery; (2) the uterine care failed to wear or after the use of the uterus to be reelected, and (3) other gynecologic diseases needed surgical treatment. In this study, the criteria used for the prolapse score were the analysis of the clinical effect of the pelvic organ prolapsed quantitation (POP-Q).2.7: the pelvic floor dysfunction questionnaire PFDI-20 and the simple questionnaire PFIQ-7 for the pelvic floor disorder (PFIQ-7) to score the quality of life before the treatment. 6 months after the treatment, 2 years PFDI after the treatment was perfected. -20, PFIQ-7 score. According to the satisfaction evaluation method of Bai and so on, the scores of life quality before and after treatment were compared, the quality of life scores and satisfaction were compared 6 months, 2 years after group treatment, and the complications were analyzed by.2.8 follow-up and statistical analysis: the main results were outpatient follow-up and telephone follow-up. 6 months after good treatment, 2 years of PFDI-20, PFIQ-7 score, detailed inquiries about the time, type and number of its complications, and record and analyze their satisfaction. All data are recorded in the EXCEL form. The data recorded are analyzed and compared with the statistical analysis software SPSS21.0, according to the different data types (quantitative data, qualitative data) And the comparison range was different (group comparison, group comparison) to use the corresponding analysis method for statistical calculation. The level of alpha =0.05, P value 0.05 was statistically significant. Results 1. silica gel and pelvic floor reconstruction for 6 months and 2 year PFDI-20, PFIQ-7 scores were lower than before treatment (P0.05). Uterine care 2 years and 6 months ratio. Compared with PFDI-20, the difference of PFIQ-7 score was not statistically significant. The P value of 0.43,0.75. pelvic floor reconstruction was compared with PFDI-20 for 2 years and 6 months, and the difference of PFIQ-7 score was statistically significant. The P value was no significant difference between 0.04,0.03.2. pelvic floor reconstruction and silicone uterine care 6 months after 6 months, PFDI-20, PFIQ-. 7 P value was 0.35,0.83.3. pelvic floor reconstruction after 2 years, the treatment effect was better than that of silica gel. The P value of PFDI-20 and PFIQ-7 had no statistically significant difference between the 6 months after the 0.00,0.02.4. pelvic floor reconstruction and the uterine care (P=0.37), and the degree of satisfaction of the operation group was higher than that of the uterine care group after 2 years of treatment (P=0). .04), the complications of pelvic floor reconstruction for long-term satisfaction compared with silica gel uterine elevation.5. were mainly: vaginal secretions increased by 17.02% (8/47), vagina odor 10.64% (5/47).6. pelvic floor reconstruction, the perioperative complications were mainly: puncture point or lower limb traction pain 13.92% (11/79), urinary retention 8.86% (7/79); postoperative long-term complications: 13. net exposure 13. 92% (11/79), new symptoms of urinary tract 10.13% (8/79). Conclusion 1. silica gel and pelvic floor reconstruction are effective methods for the treatment of severe pelvic viscera prolapse in the elderly. There is no significant difference in the short-term curative effect and satisfaction between the pelvic floor reconstruction and the silicone hysterectomy for the treatment of severe pelvic organ prolapse in the elderly, but the long-term effect and satisfaction are satisfactory. Pelvic floor reconstruction is high.3. for the elderly patients with pelvic floor reconstruction in the perioperative complications and the incidence of mesh exposure is higher in.4. elderly patients, unable to tolerate surgery or not to accept surgical treatment of patients, silica gel uterine care is a recommended treatment.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R713

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 楊曉輝;趙志英;;Prolift網(wǎng)片與聚丙烯網(wǎng)片在全盆底重建治療中的對比[J];中國組織工程研究;2016年34期

2 Yang Zhou;Ouyang Ling;Li Bo;;Expression and significance of lysyl oxidase-like 1 and fibulin-5 in the cardinal ligament tissue of patients with pelvic floor dysfunction[J];Journal of Biomedical Research;2013年01期

3 儲小燕;黃歐平;周江妍;婁俊;張倩平;梁群;黃敏;;生物反饋、電刺激聯(lián)合盆底肌鍛煉對產(chǎn)后盆底康復(fù)的療效觀察[J];現(xiàn)代婦產(chǎn)科進(jìn)展;2012年09期

4 郎景和;婦科泌尿?qū)W與盆底重建外科:過去、現(xiàn)在與將來(之二)[J];中華婦產(chǎn)科雜志;2005年03期

5 魯永鮮,劉昕,劉靜霞,張琳,張迎輝,沈文潔,胡蔓蘿,趙英;經(jīng)陰道行陰道旁修補(bǔ)術(shù)在陰道前壁及膀胱膨出治療中的應(yīng)用[J];中華婦產(chǎn)科雜志;2005年03期

，

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