本文選題：網片 + 盆底重建手術��； 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討導致使用網片盆底手術重建術后復發(fā)的相關因素、防范措施及復發(fā)后的治療,以指導臨床工作。方法:回顧性分析大連醫(yī)科大學附屬大連市婦產醫(yī)院婦科2008年3月至2016年11月使用網片行盆底重建手術治療的復發(fā)性女性盆底功能障礙性疾病行二次手術的7例患者臨床資料。結果:7例病例中,病程5～12年,平均(8.6±2.37)年,隨訪時間30～108個月,平均(78.4± 29)個月,第一次手術年齡57～73歲,平均(62 ±5.7)歲,第二次手術年齡58～75歲,平均(64.6±6.1)歲,復發(fā)相關高危因素:均為老年絕經女性,絕經年齡41～57歲,平均(49±5.4)歲,絕經時間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+加用網片的陰道前壁修補術+陰道后壁傳統修補術,術后7個月復發(fā),術后8個月因陰道后壁脫垂復發(fā)后行加用網片的陰道后壁修補術;病例二首次行保留子宮的Prolift全盆底重建術+無張力尿道吊帶術一閉孔系統(tension—free vaginal tape—obturator,TVT-O),術后 38 個月復發(fā),術后 44個月因子宮脫垂復發(fā)行腹腔鏡下全子宮切除+雙側附件切除術+加用網片的陰道骶前固定術;病例三曾行全子宮切除術,首次行全盆底重建術,術后2個月復發(fā),術后12個月因陰道穹隆脫垂復發(fā)行疝囊高位結扎術+前盆重建術;病例四首次行加用補片的陰道前壁修補術,術后即復發(fā)SUI,術后24個月行TVT-O;病例五首次行加用補片的陰道前壁修補術+TVT-O,術后18個月復發(fā),術后24個月因子宮脫垂復發(fā)行陰式全子宮切除術;病例六首次行加用補片的陰道前壁修補術,術后49個月復發(fā),術后51個月因子宮及陰道后壁脫垂復發(fā)行陰式全子宮切除術;病例七首次行保留子宮的全盆重建術,術后6個月復發(fā),術后54個月因子宮及陰道前壁脫垂復發(fā)行陰式全子宮切除術+傳統陰道前壁修補術;兩次手術后均取得了滿意的效果。結論:本組資料中使用網片行盆底重建手術后復發(fā)行二次手術的發(fā)生率1.7%。年齡大、經陰道分娩、產次、絕經、術前脫垂程度高、合并內科合并癥、便秘、術前評估不充分、術式選擇不正確、術者手術操作不到位、網片放置及固定的位置欠缺等是術后復發(fā)高危因素。復發(fā)后手術方式的選擇應從多方面進行考量,只有制定出適合的個體化治療方案才能達到最佳的治療效果。
[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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R713

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本文編號：1866519