Laparoscopic promontofixation for pelvic organ prolapse: A 10-year single center experience in a series of 501 patients
Laparoscopic promontofixation for pelvic organ prolapse: A 10-year single center experience in a series of 501 patients
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DOI：
10.1111/j.1442-2042.2011.02857.x
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发表时间：
2011-12-01
影响因子：
2.6
通讯作者：
Mandron, Eric
中科院分区：
文献类型：
--
作者：
Bacle, Julien;Papatsoris, Athanasios G.;Mandron, Eric
目的：评价腹腔镜手术治疗盆腔器官脱垂(POP)的远期疗效。患者平均年龄63.23岁(36~90岁)，平均体重指数25.14(15~36岁)，平均分娩3.3次(0~14次)。70.4%的患者被诊断为POP-gt；=3，其中38.9%的患者有腹部手术史。患者接受了Bonney试验和尿动力学检查。在压力性尿失禁(SUI)病例中，患者同时插入无张力阴道吊带。结果：平均手术时间97.4min(50~210分钟)，术中并发症发生率1.7%。平均住院时间3.7d(1~13d)。术后平均随访20.7个月(3~120个月)，共发生并发症91例(17.8%)，包括便秘(5.5%)、尿失禁(3.5%)、阴道糜烂(2.4%)、急迫性尿失禁(2%)。11.5%的患者在平均37.2个月内复发。复发的危险因素是使用聚丙烯网片与使用聚脂网片(P<；0.0001)、术中子宫切除(P=0.02)和出血(P=0.049)。脱垂生活质量问卷中大部分症状的改善具有统计学意义(P<；0.001)。结论：腰椎间盘突出症安全，远期疗效好，复发率和发病率低，生活质量好。
Objectives: To assess the long-term outcomes of laparoscopic promontofixation (LP) for the treatment of pelvic organ prolapse (POP).Methods: A total of 501 consecutive patients with POP were included in this prospective study. The patients' mean age was 63.23 (36-90) years, their mean body mass index was 25.14 (15-36) and their mean number of deliveries was 3.3 (0-14). A POP grade >= 3 was diagnosed in 70.4% of the patients and 38.9% of them had a history of abdominal surgery. The patients underwent a Bonney test and urodynamic study. In cases of stress urinary incontinence (SUI), the patients underwent the simultaneous insertion of a tension-free vaginal tape. A prolapse quality of life questionnaire was sent to all patients.Results: The mean operative time was 97.4 min (50-210) and there were 1.7% cases of intra-operative complications. The mean hospitalization time was 3.7 days (1-13 days). During the mean follow-up of 20.7 months (3-120), 91 (17.8%) complications were recorded, including constipation (5.5%), SUI (3.5%), vaginal erosion (2.4%), and urge incontinence (2%). Recurrences were recorded in 11.5% of the patients within an average time of 37.2 months. Risk factors for recurrence were the use of the polypropylene mesh compared with the polyester mesh (P < 0.0001), an intra-operative hysterectomy (P = 0.02), and bleeding (P = 0.049). There was a statistical significant (P < 0.001) improvement in most of the symptoms in the prolapse quality of life questionnaire.Conclusions: LP is safe with effective long-term results, with low recurrence and morbidity rates, and a good quality of life.