自体阔筋膜植入治疗中、重度膀胱膨出的中期疗效观察OA

Objective:To evaluate the mid-term efficacy of a single small incision tech-nique for harvesting autologous fascia lata in the treatment of moderate-to-severe cystocele.Methods:This retrospective study included 80 patients who underwent pelvic floor reconstruc-tion with autologous fascia lata augmentation for moderate-to-severe anterior vaginal wall pro-lapse at Peking University Third Hospital between February 2022 and January 2024.All patients were followed up for over one year,either in outpatient clinics or via telephone.Data collected included patient demographics and perioperative information.Follow-up assessments comprised:pre-and postoperative POP-Q staging,PFDI-20 questionnaire scores,patient satisfaction,PGI-I scores,postoperative complications,and the condition of the fascia harvesting site.Results:The average age of the 80 patients was59.2±7.00 years.The operation time for the lower limb fas-cia lata harvesting was 23.8±8.47 minutes,and the operation time for pelvic floor reconstruc-tion was 168.6±29.71 minutes.There were no intraoperative complications.The average follow-up time was 21.6±7.27 months.6.25%(5/80)of the patients felt a mass protruding from the vaginal opening.Four of them had no significant impact on their lives,and one was retreated 12 months after the operation.61.3%(49/80)of the patients returned to the outpatient depart-ment for follow-up more than one year after the operation,with an average follow-up time of 17.3±6.39 months.The POP-Q staging before and after the operation was Aa 2.7±0.94 vs-2.5±1.27(P<0.0001);Ba 4.4±1.97 vs-2.5±1.61(P<0.0001);C 1.8±3.23 vs-5.6±3.01(P<0.0001).The PFDI-20 score before and after the operation was 78.2±41.97 vs 3.3±4.84(P<0.0001).Patient satisfaction:93.7%(75/80)were very satisfied,and 6.3%(5/80)were satisfied.PGI-I score:95.0%(76/80)had very much improved,and 5.0%(4/80)had improved.Three patients were re-hospitalized for debridement due to poor healing of the vaginal apex wound 2 months after the operation(1CT2S1).Two patients developed deep vein thrombo-sis in the right lower extremity,and the thrombosis disappeared after taking anticoagulant drugs for one month.6.3%(5/80)of the patients had thigh bulge.Among them,4 cases occurred half a year after the operation,which had no impact on life and no special treatment was given.One case occurred 2 months after the operation and disappeared by itself half a year later.7.5%(6/80)of the patients had numbness or discomfort at the tendon harvesting site,which did not affect their activities or daily life.Conclusion:Autologous fascia lata augmentation for the treatment of moderate to severe anterior vaginal prolapse is safe and effective,with high pa-tient satisfaction.However,long-term follow-up is still needed to more comprehensively evaluate the surgical effectiveness and the sustained improvement in quality of life.