改良腹腔镜下五臂网片悬吊术治疗盆腔器官脱垂。
Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery.
机构信息
Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
出版信息
BMC Womens Health. 2021 Jun 15;21(1):244. doi: 10.1186/s12905-021-01388-0.
BACKGROUND
Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments.
METHODS
Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used.
RESULTS
The median post-operative follow-up was 20 (13-34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76-112) minutes. The median length of hospitalization was 2 (1-3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery.
CONCLUSIONS
In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.
背景
腹腔镜侧悬吊带术（LLS）是一种腹腔镜技术，用于治疗盆腔器官脱垂（POP），在使用合成 T 形网片移植物治疗前顶和前间隙缺陷的同时，修复后间隙。后间隙通过使用第二张网片或与 LLS 联合的手术（如后阴道修补术）进行修复。本研究旨在评估使用五臂网片而非 T 形网片移植物修复后间隙缺陷的 LLS 治疗 POP 的临床结果，除了修复前顶和前间隙。
方法
回顾性分析了 37 例诊断为晚期（≥3 期）POP 并接受 LLS 治疗的患者数据，使用五臂网片。确定了术前和术后检查以及手术结果。分析了测量和检查结果、再次手术率、侵蚀率、下尿路症状和并发症。还使用了脱垂生活质量问卷（P-QOL）。
结果
中位术后随访时间为 20 个月（13-34 个月）。所有治疗部位的 POP-Q 评分均有显著改善，顶间隙的总体客观治愈率为 94.5%，前间隙为 86.4%，后间隙为 91.8%。中位手术时间为 96 分钟（76-112 分钟）。中位住院时间为 2 天（1-3 天）。术后阴道膨出、尿急、不完全排空、尿频和便秘均有显著改善。患者的性生活从术前的 13 例（35.1%）增加到术后的 22 例（59.4%）。新发性压力性尿失禁在 7 例（18.9%）患者中发生。术后 P-QOL 评分显著提高。
结论
在晚期 POP 患者中，使用单个五臂网片也可以在 LLS 中修复后间隙损伤，而无需额外的手术，从而降低复发率。
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