切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (04) : 223 -228. doi: 10.3877/cma.j.issn.1674-6899.2020.04.007

所属专题: 文献

论著

腹腔镜骶骨固定术相关并发症的回顾:7年单中心临床分析
赵成志1, 卢深涛1, 王荥1, 刘明博1, 孙玉菡1, 雷丽1, 刘禄斌1,()   
  1. 1. 400021 重庆市妇幼保健院妇科盆底与肿瘤科
  • 收稿日期:2020-04-07 出版日期:2020-08-30
  • 通信作者: 刘禄斌
  • 基金资助:
    重庆市自然科学基金(cstc2019jcyj-msxm0877); 重庆市技术创新与应用示范(社会民生类一般)项目(cstc2018jscx-msyb0800)

Complications associated with laparoscopic sacral fixation: a 7-year single center clinical analysis

Chengzhi Zhao1, Shentao Lu1, Ying Wang1, Mingbo Liu1, Yuhan Sun1, Li Lei1, Lubin Liu1,()   

  1. 1. Gynecology Pelvic Floor and Oncology Department Chongqing Maternal and Child Health Hospital, Chongqing 400021, China
  • Received:2020-04-07 Published:2020-08-30
  • Corresponding author: Lubin Liu
  • About author:
    Corresponding author: Liu Lubin, Email:
引用本文:

赵成志, 卢深涛, 王荥, 刘明博, 孙玉菡, 雷丽, 刘禄斌. 腹腔镜骶骨固定术相关并发症的回顾:7年单中心临床分析[J/OL]. 中华腔镜外科杂志(电子版), 2020, 13(04): 223-228.

Chengzhi Zhao, Shentao Lu, Ying Wang, Mingbo Liu, Yuhan Sun, Li Lei, Lubin Liu. Complications associated with laparoscopic sacral fixation: a 7-year single center clinical analysis[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(04): 223-228.

目的

回顾性分析重庆市妇幼保健院行腹腔镜骶骨固定术7年的临床资料,分析总结该术式的相关并发症及处理。

方法

收集2012年1月至2019年11月接受腹腔镜骶骨固定术的238例患者的临床随访资料,统计分析手术前后POP-Q的Ba、Bp、C、D位点等各指示点及生存质量和性生活状态评分的变化,术后各类并发症的处理情况。

结果

腹腔镜骶骨固定术治疗中盆腔缺陷的有效方式,其治愈率为98.74%;Ba、Bp、C、D位点,以及PFDI-20和PISQ-12问卷均有明显改善,术后生存质量及性生活状态改善。术后的并发症发生率约15.55%,其中便秘发生率最高(约5.04%),其次为疼痛3.78%,网片暴露、新发尿失禁、骶前出血、尿潴留的发生率均1.26%;复发、严重感染发生率0.84%,性生活障碍、输尿管折叠梗阻、尿道损伤发生率0.42%;所有并发症均经相应处理治愈。

结论

腹腔镜骶骨固定术是治疗中盆腔缺陷的有效方式,效果满意,但需重视手术网片并发症的预防及处理,对并发症的合理治疗可以改善患者的预后。

Objective

To analyze the clinical data of laparoscopic sacral fixation in our hospital for 7 years, analyze and summarize the related complications and treatment.

Methods

The clinical follow-up data of 238 patients who underwent laparoscopic sacral fixation from Jan. 2012 to Nov. 2019 in the department of gynecology and pelvic floor and oncology of Chongqing maternal and child health hospital were collected, and the changes of Ba, Bp, C, D and other indicators of POP-Q before and after the operation, the quality of life and the score of sexual activity, and the treatment of various complications and complications after the operation were statistically analyzed.

Result

Laparoscopic sacral fixation can treat pelvic organ prolapse with pelvic cavity defects, and the quality of life and sexual life improved after operation.The cure rate of all patients receiving sacral fixation is 98.74%, and the incidence of complications is about 15.55%.The incidence of constipation is about 5.04%, followed by pain, 3.78%, net exposure, new urinary incontinence, presacral bleeding and urinary retention. The incidence of recurrence and serious infection was 0.84%, sexual life disorder, ureteral fold obstruction and urethral injury was 0.42%, all complications were cured.

Conclusions

Laparoscopic sacral fixation is an effective method for the treatment of pelvic defects.There are corresponding complications of operation and mesh.Reasonable treatment can improve the prognosis of patients.

图1 238例腹腔镜骶骨固定术患者各术式分布情况
表1 238例腹腔镜骶骨固定术患者一般情况及不同手术类型
表2 238例腹腔镜骶骨固定术患者不同手术类型前后POP-Q各位点[M(IQR)]
表3 238例腹腔镜骶骨固定术患者不同手术类型前后PFDI-20及PISQ-12(±s)
表3 238例腹腔镜骶骨固定术患者不同手术类型的并发症发生情况
1
Pacquée S, Nawapun K, Claerhout F,et al.Long-term assessment of a prospective cohort of patients undergoing laparoscopic sacrocolpopexy[J].Obstet Gynecol,2019,134(2): 323-332.
2
王延洲,梁志清.腹腔镜下盆底结构重建经验与思考[J/CD].中华腔镜外科杂志(电子版),2019,12(5): 264-266.
3
Elneil S, Cutner AS, Remy M,et al.Abdominal sacrocolpopexy for vault prolapse without burial of mesh:a case series[J].BJOG,2005,112(4): 486-489.
4
Karon M, Chatterjee S.Sacrocolpopexy: patient outcomes support the use of non-crosslinked acellular dermal matrix as an alternative to the synthetic polypropylene mesh[J].J Gynecol Surg,2019,35(6): 337-344.
5
De Tayrac R, Sentilhes L.Complications of pelvic organ prolapse surgery and methods of prevention[J].Int Urogynecol J Pelvic Floor Dysfunct,2013,24(11): 1859-1872.
6
Filmar GA, Fisher HW, Aranda E,et al.Laparoscopic uterosacral ligament suspension and sacral colpopexy:results and complications[J].Int Urogynecol J,2014,25(12): 1645-1653.
7
Theobald P, Chéret Angélique. Laparoscopic sacrocolpopexy: results of a 100-patient series with 8 years follow-up[J]. Gynecological Surgery, 2004, 1(1): 31-36.
8
North CE, Ali-Ross NS, Smith AR,et al.A prospective study of laparoscopic sacrocolpopexy for the management of pelvic organ prolapse[J].BJOG,2009, 116(9): 1251-1257.
9
Nygaard IE, McCreery R, Brubaker L,et al.Abdominal sacrocolpopexy: a comprehensive review[J].Obstet Gynecol,2004,104(4): 805-823.
10
Vincent Misraï, Morgan Rouprêt, Florence Cour,et al.De novo urinary stress incontinence after laparoscopic sacral colpopexy[J].BJU Int,2008,101(5): 594-597.
11
Rozet F, Mandron E, Arroyo C,et al.Laparoscopic sacralcolpopexy approach for genito-urinary prolapse: experience with 363 cases[J].Eur Urol,2005, 47(2): 230-236.
12
Braun NM, Andraos W, Bettin S.Safety and efficacy of spider anchoring device for apical repair in laparoscopic sacrocolpopexy: Retrospective cohort study[J].Eur J Obstet Gynecol Reprod Biol,2019,235(1): 88-92.
13
Ross JW, Preston M.Laparoscopic sacrocolpopexy for severe vaginal vault prolapse:five-year outcome[J].J Minim Invasive Gynecol,2005,12(3): 221-226.
14
Apostolopoulos NV, Alexandraki KI, Gorry A,et al.The early benefits of laparoscopic Sacrocolpopexy[J].J Gynecol Obstet Hum Reprod,2019,48(10): 799-804.
15
Abdullah B, Nomura J, Moriyama S,et al.Clinical and urodynamic assessment in patients with pelvic organ prolapse before and after laparoscopic sacrocolpopexy[J].Int Urogynecol J,2017,28(10): 1543-1549.
16
Daneshgari F, Kong W, Swartz M.Complications of mid urethral slings: important outcomes for future clinical trials[J].J Urol,2008,180(5): 1890-1897.
17
Braun NM, Andraos W, Bettin S.Safety and efficacy of spider anchoring device for apical repair in laparoscopic sacrocolpopexy: retrospective cohort study[J].Eur J Obstet Gynecol Reprod Biol,2019,235(1): 88-92.
18
Danford JM, Osborn DJ, Reynolds WS,et al.Postoperative pain outcomes after transvaginal mesh revision[J].Int Urogynecol J,2015,26(1): 65-69.
19
Eisenberg VH, Steinberg M, Weiner Z,et al.Long-term follow-up of sacrocolpopexy mesh implants at two time intervals at least 1 year apart using 4D transperineal ultrasound[J].Ultrasound Obstet Gynecol,2017,49(3): 398-403.
20
Tan-Kim J, Menefee SA, Luber KM,et al.Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy[J].Int Urogynecol J,2011,22(2): 205-212.
21
Osmundsen BC, Clark A, Goldsmith C,et al.Mesh erosion in robotic sacrocolpopexy[J].Female Pelvic Med Reconstr Surg,2012,18(2): 86-88.
22
Nygaard I, Brubaker L, Zyczynski HM,et al.Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse[J].JAMA,2013,309(19): 2016-2024.
23
Stepanian AA, Miklos JR, Moore RD,et al.Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic-assisted vaginal hysterectomy: experience of 402 patients[J].J Minim Invasive Gynecol,2008,15(2): 188-196.
24
Boyd B, Pratt T, Mishra K.Fungal lumbosacral osteomyelitis after robotic-assisted laparoscopic sacrocolpopexy[J].Female Pelvic Med Reconstr Surg,2018,24(6): 46-48.
25
Zebede S, Dawood A, Alarab M,et al.A streamlined surgical approach to laparoscopic sacrocolpopexy for post-hysterectomy vault prolapse[J].J Obstet Gynaecol Can,2016,38(5): 446-452.
26
张晓薇,陈礼全.阴道-骶骨固定术手术区域应用解剖研究[J].中国实用妇科与产科杂志,2009,25(8): 590-593.
27
Braley SC, Schneider PD, Bold RJ,et al.Controlled tamponade of severe presacral venous hemorrhage: use of a breast implant sizer[J].Dis Colon Rectum,2002,45(1): 140-142.
[1] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[2] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[3] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[4] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[5] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[6] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[7] 陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[8] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[9] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[10] 刘柏隆, 周祥福. 压力性尿失禁阶梯治疗的项目介绍[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 125-125.
[11] 刘柏隆. 女性压力性尿失禁阶梯治疗之手术治疗方案选择[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 126-126.
[12] 公宇, 廖媛, 尚梅. 肝细胞癌TACE术后复发影响因素及预测模型建立[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 818-824.
[13] 李一帆, 朱帝文, 任伟新, 鲍应军, 顾俊鹏, 张海潇, 曹耿飞, 阿斯哈尔·哈斯木, 纪卫政. 血GP73水平在原发性肝癌TACE疗效评价中的作用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 825-830.
[14] 王誉英, 刘世伟, 王睿, 曾娅玲, 涂禧慧, 张蒲蓉. 老年乳腺癌新辅助治疗病理完全缓解的预测因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 641-646.
[15] 崔军威, 蔡华丽, 胡艺冰, 胡慧. 亚甲蓝联合金属定位夹及定位钩针标记在乳腺癌辅助化疗后评估腋窝转移淋巴结的临床应用价值探究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 625-632.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?