两种阴道黏膜切口缝合方法治疗前盆腔脱垂的效果及阴道微生态变化分析

Efficacy and vaginal microecology changes of two suture methods of vaginal mucosal incision in implanting mesh for treatment of patients with anterior pelvic prolapse

关键词:  盆腔器官脱垂  临床疗效  Tiloop网片  阴道微生态

Key words:  pelvic organ prolapse  clinical efficacy  TiLOOP total4  vaginal microecology

摘要:

目的评价经阴道前壁植入TiLOOP Total4网片，阴道黏膜切口不同缝合方法，治疗中重度前盆腔脱垂的临床疗效、网片暴露及阴道微生态变化。 方法分析2021年6月至2023年6月，于上海中医药大学附属普陀医院妇科就诊，经POP-Q评分为ⅢⅣ度的前盆腔脱垂初治患者及未使用植入物术后复发者共61例，随机分成两组，均行单纯前盆腔重建术，31例常规阴道黏膜缝合组为对照组（A组），30例改良阴道黏膜缝合组为研究组（B组），观察手术时间、手术中的出血量、术后住院天数；收集疗效的主观评价指标[盆腔器官脱垂及尿失禁性生活问卷（PISQ-12评分量表）、盆底功能影响问卷简表（PFIQ-7）]及客观评价指标（POP-Q术前后测量指标）数据；术前、术后阴道微生态变化的数据；术后是否出现网片暴露。 结果两组手术时间、术中出血量相比，差异无统计学意义（P>0.05）。与A组比较，B组术后住院天数缩短。B组Aa、Ba、C、Ap、Bp点术后上升更明显（P<0.05）。术后6个月PISQ-12量表评分B组明显提升(P<0.05)；术后1、6个月PFIQ-7量表评分B组“膀胱或尿道”“阴道或盆腔”亚类差异有统计学意义(P<0.05)。而肠道亚类差异无统计学意义(P>0.05)。术后1个月，B组阴道优势菌为乳杆菌、pH等指标更接近绝经期女性的阴道微生态状态，较A组差异有统计学意义(P<0.05)，术后6个月网片暴露并发症A组1例，B组无。 结论经阴道前壁植入TiLOOP Total4网片后，两种阴道黏膜不同缝合方法，对中重度前盆腔脱垂治疗疗效确切；改良阴道黏膜缝合组患者满意度更好，且对阴道微生态有更早更好的纠正作用。

Abstract:

Objective To investigate serum cytokine and C-reactive protein(CRP) levels in different types and severity of hip fractures. Methods A total of 278 consecutive patients with hip fractures were recruited from September 2020 to July 2023, including 151 cases of hip neck fractures and 127 cases of intertrochanteric fractures. Patients were categorized into less severe and severe fracture groups based on the Garden classification for femoral neck fractures and the AO/OTA classification for intertrochanteric fractures. Serum cytokine and CRP expression levels were tested for all patients. Results Serum levels of IL-6, IL-8, IL-10, and TNF-α were significantly higher in the severe fracture group compared to the less severe fracture group(P<0.05). For different types of fractures, serum levels of IL-6 and CRP were significantly higher in the intertrochanteric fracture group compared to the femoral neck fracture group(P<0.05), while there were no significant differences in serum IL-8, IL-10, and TNF-α levels between patients with intertrochanteric fractures and those with femoral neck fractures. After adjusting for height, weight, and BMI, serum levels of IL-6, IL-8, and CRP were significantly elevated in the severe fracture group(P<0.05), particularly for IL-6 and IL-8 in the intertrochanteric fracture patients(P=0.00). Conclusion The elevation of serum IL-6, IL-8, IL-10 and TNF-α levels are associated with the severity of hip fractures, while the CRP and IL-6 levels in patients with intertrochanteric fractures are higher than those with hip neck fractures.