课件：盆底重建的历史.ppt

Gynecare PROLIFT*全片植入 盆底重建术(骶骨阴道固定术) 是顶部脱垂修补的金标准 两补片缝在阴道前后壁，固定在骶岬处 盆底重建手术的目的 安全 性功能 排泄节制 耐久性 脱垂消除 成功的手术结果 轻度膨出无症状者：观察、随访 轻度膨出有症状者：非手术治疗 中度以上膨出患者：手术治疗 盆底重建的手术原则 盆底重建操作技术的原则 无张力置入 尽量分离缺损空间使植入物覆盖范围广。 网带缝合在阴道近段，固定于坐骨棘附近。 不需修剪阴道壁，术后会回缩，保持阴道壁有一定厚度。 手术方式灵活多样 骨盆底前部修补 骨盆底后部修补 整体修补 （伴或不伴子宫切除） 谢谢您的观看 THANK YOU SUCCESS * * 可编辑 * * * * * * * * * * * * * * * * The surgical technique was refined over a 5-year period through 600+ surgical interventions by the 9 French gynecologic experts. The group assessed implant shapes, sizes, and material composition, incision and dissection techniques, and implant fixation points. The assessment culminated in a combined United States and French prospective clinical trial that began in late 2004 with a 1, 3, and 5-year follow up. It was important for the technique to entail tension-free placement of the mesh implant with broad coverage. Through cadaveric work, the group analyzed various fixation points such as the iliococcygeus muscle, obturator membrane, and sacrospinous ligament. They also looked at the force to displace the mesh implant when fixated to these anatomic structures. It was determined that displacement of the implant was greater earlier in the timeline and decreased as time passed. Also, the force to displace a 2 cm implant strap was much less than displacing a 1 cm implant strap. Therefore, the group concluded that it was important to design the implant with 2 cm straps and to place them tension free through substantial anatomic structures such as the sacrospinous ligament and obturator membrane. 可编辑 可编辑 盆底重建的历史 常见女性泌尿疾患 膀胱活动过度症（OAB） 压力性尿失禁（SUI） 女性盆腔脏器脱垂（POP） 女性间质性膀胱炎（IC） 女性排尿障碍（FBOO） 膀胱、尿道阴道瘘（VVF） 女性尿道疾患 女性性功能障碍 盆底功能障碍性疾病 盆底功能障碍性疾病 三大疾病： 尿失禁、盆腔器官脱垂、大便失禁 发病率被低估，既往重视少。 严重影响生活质量。 医疗消费大。 尿失禁与盆腔脏器脱垂 50%的成年女性有过尿失禁的经历 5%-25%的成年女性至少每周有一次尿失禁发生 5%-15%的女性每天或大多数时候都有尿失禁发生 11.1%的妇女在80岁以前因脱垂或尿失禁可能接受一次手术，其中高达三分之一的手术是重复的 2002年，女性压力性尿失禁的手术高达18.8万台、生殖道脱垂手术为26.6万台 我国盆底重建处于起步阶段，其接受手术的患者率接近BPH。 盆底重建的历史