最新盆底外科相关问题伊宁.ppt

局部修补(Repairment) 折叠术不能达到预想结果，希望用补片修补。 局部修补指用补片修补缺损。 类似修补轮胎。 盆底重建与传统手术的主要不同之处？ ——重建(Reconstruction) 长久的修补应当是重建 要达到重建的效果 不能依赖缺损组织 必须保证阴道 全长、全宽、全厚 维持功能的解剖形态 必须固定在无缺损的组织上 阴道折叠术 Plication 局部修补 Repairment 重建手术 Reconstruction  盆底修复手术的历程 盆底重建操作技术的原则 寻找缺损空间使植入物均匀覆盖。 无张力、平铺置入 网带缝合在阴道近段（宫颈低位），固定于坐骨棘附近。 不需修剪阴道壁，术后回缩，保持阴道壁原有厚度。 手术方式灵活多样 保持阴道全长、全宽、全厚，恢复阴道功能形状 盆底重建手术技巧 盆底筋膜层注水——“变胖不变白” 分离阴道壁全层——“剪水技术” 膀胱、直肠阴道间隙—— “乘虚而入” 清楚辨别坐骨棘——“高位吊顶” 手指引导穿刺针——“保护患者” 依据间隙大小裁减网片——“量体裁衣” 平铺网片——“被套与棉絮” 常见并发症  1、术中分离膀胱破裂 2、术中穿刺 穿入膀胱 3、阴道裂开，网片显露 4、出血、瘀斑、血肿形成 5、直肠损伤 * In a survey1 of a general population of 2,979 women aged 45 to 85 years, 75% experienced some level of pelvic organ prolapse (POP). This percentage generally increased with increasing age. In a large database study of 1,912 women, symptoms of prolapse were assessed in relation to prolapse and POP-Q examination findings. In this study, 54% of women with symptomatic prolapse (vaginal bulge) had POP-Q Stage II prolapse, 11% had Stage III prolapse, and 36% had Stage IV prolapse.2,3 The calculations for obtaining these percentages (based on Tan et al3) are shown below. 1. Slieker-ten Hove MCPh, Pool-Goudzwaard AL, Eijkemans MJC, Steegers-Theunissen RPM,  Burger CW, Vierhout ME. The prevalence of pelvic organ prolapse symptoms and signs and their  relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic  Floor Dysfunct. 2009;20:1037-1045. 2. Data on file. Ethicon Women’s Health Urology. Somerville, NJ, USA. 3. Tan JS, Lukacz ES, Menefee SA, Powell CR, Nager CW. Predictive value of prolapse symptoms:  a large database study. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:203-209. Slieker-ten Hove, p.1042, A3 Slieker-ten Hove, p.1052, A3 and table 2 Stage II Stage III Stage IV Total N 295 368 123 81 289 % Symptomatic 24% 49% 77% 85% 79% Symptomatic 71 180 95 69 228 643 % by Stage 54% 11% 36% Tan, p.206, Figure 1 PROSIMA positioning fina