摘要 目的探讨盆底重建术后网片或吊带暴露及复发再入院原因及防治方法。方法收集2008年1月至2020年1月于大连市妇幼保健院因盆腔器官脱垂(POP)、压力性尿失禁(SUI)应用网片或吊带手术治疗,术后因网片或吊带暴露及复发再入院治疗的12例患者临床资料,回顾性分析再入院原因及防治方法。结果再入院原因:网片或吊带暴露占50.00%,POP、SUI复发占66.67%。网片暴露再入院治疗发生于经阴道全盆重建术后3例、腹腔镜骶骨固定术(LSC)术后2例,均为阴道顶端暴露;1例吊带暴露发生于经阴道单切口吊带术后。网片暴露者行暴露网片切除术,吊带暴露者除行暴露网片切除术外、因疼痛行固定锚栓切除术。7例POP术后复发中6例为中盆腔缺陷复发伴或不伴有阴道前、后壁的脱垂,再入院行全子宫切除术5例,其中2例同时行阴道顶端的悬吊及缺陷部位的修补;1例阴道穹隆及阴道前壁脱垂者行疝囊高位结扎术及前盆重建术。1例SUI术后复发者行经闭孔阴道无张力尿道中段悬吊术(TVT-O)。因网片或吊带暴露及复发3次入院手术治疗共3例。所有病例至随访结束,无网片或吊带暴露及复发。结论经阴道全盆重建术、LSC术后网片阴道顶端暴露者需再入院处理,POP盆底重建术前应准确评估盆底缺陷部位,个体化选择手术方式,术中注意第一水平加固,降低术后中盆腔缺陷复发风险,以减少再入院率。 Objective sling exposure and recurrence after pelvic floor reconstruction.Methods pelvic organ prolapse(POP)and stress urinary incontinence(SUI)treated by mesh or sling in Dalian Maternal and Child Health Care Hospital from January 2008 to January 2020,who were readmitted to the hospital for exposure of mesh or sling and recurrence.The causes and methods of prevention and treatment were analyzed retrospectively.Results readmission reasons were :mesh or sling exposure accounting for 50.00%,POP and SUI recurrence accounting for 66.67%.Mesh exposure readmission occurred in 3 cases after transvaginal pelvic reconstruction and 2 cases after laparoscopic sacral fixation(LSC),both of which were top vagina exposure;1 case of sling exposure occurred after vaginal single incision sling operation.Mesh exposure was treated with resection of exposed mesh,and sling exposure was treated with resection of exposed mesh and fixed anchor bolt resection owing to pain.Among the 7 cases of POP recurrence,6 cases had pelvic defect recurrence with or without anterior and posterior vaginal wall prolapse.Five cases were readmitted to the hospital for total hysterectomy,2 cases of which underwent vaginal top suspension at the same time and repair of defect site;1 case of vaginal vault and anterior vaginal wall prolapse underwent high ligation ofhernia sac and anterior pelvic reconstruction.One caseof recurrence after SUI underwent TVT-O.There were 3 cases with 3 times of readmission owing to mesh orsling exposure or recurrence.No mesh or slingexposure or recurrence was found in all cases till the end of follow-up.ConclusionThe top of vagina exposure after transvaginal pelvic reconstruction and LSC needsreadmission for treatment.Before the POP pelvic floor reconstruction,we should accurately assess the site of pelvic floordefects,and select individualized surgical methods.Pay attention to reinforce the first level of pelvic floors during theoperation to reduce the risk of recurrence of pelvic defects and reduce the readmission rate.
出处 《中国实用妇科与产科杂志》 CAS CSCD 北大核心 2021年第4期486-489,共4页 Chinese Journal of Practical Gynecology and Obstetrics
基金 辽宁省自然科学基金(20180550533)。
