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目的初步探讨脱细胞生物组织补片在盆腔器官膨出患者盆底重建手术中的应用情况。方法选择北京大学人民医院妇科2006年5月至12月期间接受盆底修补和重建手术并应用脱细胞生物补片的盆腔器官膨出患者20例,其中子宫脱垂19例,子宫切除术后阴道穹隆脱垂Ⅱ度1例;合并存在膀胱膨出20例、直肠膨出17例。20例患者中17例同时行阴道前后壁修补术,3例行阴道前壁修补术;阴道前壁置入补片15例,阴道后壁置入补片2例,阴道前壁和后壁同时置入补片3例。结果 20例患者总于术时间平均为113.1 min(70～180 min),其中放置补片的时间平均为10 min。术中出血平均为175 ml(50～300 ml)。术后恢复良好,平均随访9.3个月(6～12个月),未发现补片侵蚀阴道黏膜情况,无感染发生。随访期间4例(20%)患者出现盆腔器官膨出复发,3例为膀胱膨出Ⅰ度,复发时间均为6个月复查时,其中2例随访12个月时仍为膀胱膨出Ⅰ度,另1例随访8个月时也为膀胱膨出Ⅰ度,未见加重;1例为膀胱膨出Ⅱ度,复发时间为6个月复查时;所有复发患者均无临床症状。结论脱细胞生物组织补片用于盆底重建于术,方法简单,操作容易,未见补片侵蚀发生,其长期效果有待进一步观察。
Objective To investigate the application of acellular biological tissue patch in pelvic floor reconstruction of patients with pelvic organ bulging. Methods 20 cases of pelvic organ bulging who underwent pelvic floor repair and reconstruction surgery and acellular biological patch during the period from May to December 2006 were selected from Department of Gynecology, Peking University People’s Hospital. Among them, 19 cases were uterine prolapse, Formal prolapse Ⅱ degree in 1 case; merger bladder cyst 20 cases, rectocele in 17 cases. Among the 20 patients, 17 cases underwent vaginal anterior and posterior wall repair and 3 cases underwent vaginal anterior wall repair. There were 15 cases with anterior vaginal wall insertion, 2 cases with posterior vaginal wall insertion and 2 cases with vaginal anterior and posterior walls Pouch into 3 cases. Results The total time of operation in 20 patients was 113.1 min (70-180 min), and the average time for placement of patch was 10 min. Intraoperative bleeding average 175 ml (50 ~ 300 ml). Postoperative recovery was good, the average follow-up of 9.3 months (6 to 12 months), no patch erosion of the vaginal mucosa, no infection occurred. During the follow-up period, pelvic organ bulging recurrence occurred in 4 cases (20%), cystocele Ⅰ in 3 cases, and recurrence time in 6 months. Two of them were cystocele Ⅰ , And the other 1 case was cystic prolapse Ⅰ degree at 8 months follow-up. No cystocele Ⅱ degree was observed in one case, and the recurrence time was 6 months. All patients had no clinical symptoms. Conclusion Acellular biological tissue patch for pelvic floor reconstruction, the method is simple, easy to operate, no patch erosion occurs, the long-term results need to be further observed.