Gao Zhen-Hua, Wang Xing-Qi, Ke Kun-Bin, Zhang Quan, Li Ling, Shen Ji-Hong
Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China.
Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming, 650032, China.
Curr Med Sci. 2025 Aug;45(4):909-916. doi: 10.1007/s11596-025-00095-3. Epub 2025 Jul 30.
This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.
From December 2014 to August 2021, 517 women were included and registered for physiological reconstruction at four Chinese urogynecology institutions. We enrolled 364 women with POP-Q stage ≥ 3. The degree of POP was quantified via a POP-Q system. The surgical purpose of physiological reconstruction is to repair the vagina, levator ani muscle, perineum, and urogenital hiatus and adopt a repair method in accordance with the axial direction of physiology. All 330 evaluable participants were followed for 2 years. The evaluation indices included the PFDI-20, PGI-I, PFIQ-7, PISQ-12, PGI-I, and PGI-S. All complications were coded according to the category-time-site system proposed by the International Urogynecological Association (IUGA) and International Continence Society (ICS).
Compared with the preoperative POP-Q scores, statistically significant improvements were observed at the 6-month, 1-year and 2-year time points (P < 0.001). Statistically significant improvements in quality of life were observed across all time points.
Physiologic reconstructive surgical techniques combined with modified anterior pelvic floor mesh implantation could help restore the physiologic axis and vaginal shape, which may be the most important factors in maintaining the functional position of pelvic floor organs and is the most effective method for repairing the pelvic fascia tendon arch. This surgical method is safe, feasible, and effective in patients with severe prolapse.
本研究是一项基于生理重建治疗中重度盆腔器官脱垂的临床疗效及并发症的自身对照多中心回顾性研究。
2014年12月至2021年8月，纳入中国4家女性盆底疾病诊治机构的517例行生理重建术的女性患者并进行登记。我们纳入了364例POP-Q分期≥3期的女性。通过POP-Q系统对盆腔器官脱垂程度进行量化。生理重建术的手术目的是修复阴道、肛提肌、会阴及泌尿生殖裂孔，并按照生理轴向采用修复方法。对所有330例可评估参与者进行了2年的随访。评估指标包括PFDI-20、PGI-I、PFIQ-7、PISQ-12、PGI-I和PGI-S。所有并发症均按照国际尿控协会（IUGA）和国际尿失禁学会（ICS）提出的分类-时间-部位系统进行编码。
与术前POP-Q评分相比，在6个月、1年和2年时间点观察到有统计学意义的改善（P<0.001）。在所有时间点均观察到生活质量有统计学意义的改善。
生理重建手术技术联合改良盆底前壁补片植入有助于恢复生理轴线和阴道形态，这可能是维持盆底器官功能位置的最重要因素，也是修复盆筋膜腱弓的最有效方法。该手术方法对重度脱垂患者安全、可行且有效。
