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目的探讨因子宫脱垂或其他因素行全子宫切除术后发生穹隆疝的处理方式。方法对2011年1月至2015年12月就诊于中国医科大学附属盛京医院行全子宫切除术后发生盆腔器官脱垂107例及其中的80例穹隆疝患者的手术处理方式进行回顾性分析。结果 107例患者中,单纯膀胱膨出或直肠膨出27例;以穹隆膨出为主,伴或不伴有膀胱和直肠膨出80例。80例患者中,子宫脱垂行全子宫切除32例,其他原因行全子宫切除48例;重度压力性尿失禁14例,尿动力学提示隐匿性尿失禁3例;行经阴道置入网片的盆底重建术76例,其中全盆底重建术56例,中盆腔重建术20例;2例腹腔镜下阴道骶骨固定术,1例单纯疝囊修补术,1例前盆底重建术+疝囊修补术。17例压力性尿失禁患者中,16例术中同时行TVT-O术。随访至2016年12月,平均随访时间38个月,无复发病例,3例患者出现网片暴露,1例隐匿性尿失禁患者于术后1年因尿失禁症状较重,行TVT-O手术。结论置入网片的盆底重建术是治疗子宫切除术后阴道穹隆疝的一种有效的手术方式,术前根据穹隆疝及合并阴道前后壁脱垂的程度选择恰当的手术重建方式。对于术前合并压力性尿失禁或隐匿性尿失禁患者术中应同时行TVT-O手术。
Objective To investigate the treatment of vault herniation after hysterectomy due to uterine prolapse or other factors. Methods A retrospective analysis of 107 cases of pelvic organ prolapse and 80 cases of dome-shaped herniation occurred after hysterectomy was performed in Shengjing Hospital Affiliated to China Medical University from January 2011 to December 2015 was retrospectively reviewed. Results Of the 107 patients, only cystocele or rectocele was found in 27 cases. The most prominent bulging dome was with or without bladder and rectocele in 80 cases. In 80 patients, hysterectomy was performed in 32 cases of uterine prolapse and 48 cases of hysterectomy in other reasons; 14 cases of severe stress urinary incontinence and 3 cases of urinary incontinence in urodynamics; Pelvic floor reconstruction in 76 cases, including pelvic floor reconstruction in 56 cases, pelvic reconstruction in 20 cases; 2 cases of laparoscopic vaginasacral fixation, 1 case of simple hernia repair, anterior pelvic floor reconstruction + hernia Pouch repair. Of the 17 patients with stress urinary incontinence, TVT-O was performed in 16 patients during operation. All the patients were followed up until December 2016. The average follow-up time was 38 months. There were no recurrences, 3 cases of retinal detachment and 1 case of occult urinary incontinence due to severe incontinence 1 year after operation. The patients underwent TVT-O surgery . Conclusion Reconstruction of the pelvic floor inserted into the mesh is an effective surgical treatment of vaginal vault hernia after hysterectomy. According to the degree of dome-shaped hernia and prolapinal anterior and posterior wall prolapse, select the appropriate surgical reconstruction. For preoperative patients with stress incontinence or occult urinary incontinence should be performed simultaneously with TVT-O surgery.