自裁网片的改良全盆底悬吊手术对POP患者盆底肌力的干预效果

Modified total pelvic reconstruction with polypropylene mesh for patients with pelvic organ prolapse

关键词:  改良全盆底悬吊手术  Prolift手术  盆底肌力  表面肌电图  Ⅰ类肌纤维  Ⅱ类肌纤维

Key words:  modified total pelvic reconstruction  Prolift procedure  pelvic muscle strength  the surface EMG  type I muscle fiber  Type Ⅱmuscle fiber

摘要:

目的 评估自裁网片的改良全盆底网片悬吊手术对盆腔器官脱垂（pelvic organ prolapse, POP）患者盆底肌力的干预效果。方法 选择我院妇科因盆腔器官脱垂要求手术入院患者105例，分为2组，研究组68例，接受改良全盆底网片悬吊手术；对照组37例，接受Prolift手术；另选择30例因其他妇科疾病(排除合并盆腔器官脱垂或压力性尿失禁者)同期入院手术的患者，作为正常人对照组。采用经阴道内表面电极肌电图对研究组、对照组及正常人组患者在术前和术后3月时进行测定，记录并分析正常人组和2组POP患者的手术前后盆底肌力数据，并对2组POP患者手术后盆底肌力改善程度进行深入的对比分析。结果 研究组与对照组手术后Ⅰ类肌纤维持续收缩电压、持续时间有明显改善，差异有统计学意义(P<0.05)，Ⅱ类肌纤维的快速收缩电压、收缩个数也有明显改善，差异有统计学意义(P<0.05)。对比2种术式对Ⅰ类肌纤维、Ⅱ类肌纤维各指标的改善程度，结果显示差异无统计学意义（P>0.05）。结论 自裁网片的改良全盆底网片悬吊手术和Prolift手术均能明显改善POP患者的盆底肌力；在改善POP患者盆底肌力程度上，自裁网片的改良全盆底网片悬吊手术与Prolift手术效果相当。

Abstract:

Objective To evaluate the application of the modified total pelvic reconstruction operation with polypropylene mesh in patients with pelvic organ prolapse (POP). Methods Clinical data of 105 POP patients admitted from March 2008 to April 2010 were retrospectively reviewed. Among 105 patients 68 cases received the modified total pelvic reconstruction with polypropylene mesh (reconstruction group) and 37 patients received Prolift operation (Prolift group). And 30 non-POP patients admitted during the same period served as controls. Pelvic muscle strength was examined with pelvic surface electromyography before and 3 months after surgery. Results Non-parametric Wilcoxon test showed significant improvement in voltage for sustained contraction and duration for type I fiber of pelvic muscle after surgery（P<0.05）, number of contraction and quick contraction of the median voltage of type Ⅱ fiber also showed significantly improvement (P<0.05). There was no significant difference in improvement of type I and type Ⅱ muscle fibers index between two groups（P>0.05）. Conclusion Both the modified total pelvic reconstruction with polypropylene mesh and Prolift operation can significantly improve pelvic muscle strength.