腹腔镜下经阴道子宫全切术联合阴道前后壁修补术治疗老年子宫脱垂效果  

Effectiveness of laparoscopic total transvaginal hysterectomy combined with anterior and posterior vaginal wall repair in the treatment of uterine prolapse in the elderly

作　　者：赵宏霞 刘静 李晓薇 陈金婵 汪志霞[2] Zhao Hongxia;Liu Jing;Li Xiaowei;Chen Jinchan;Wang Zhixia(Department of Gynecology,Taikang Xianlin Drum Tower Hospital,Nanjing,Jiangsu 210046,China;Department of Obstetrics and Gynecology,BenQ Hospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu 210000,China)

机构地区：[1]泰康仙林鼓楼医院妇科,南京210046 [2]南京医科大学附属明基医院妇产科,210000

出　　处：《中华疝和腹壁外科杂志（电子版）》2023年第5期561-565,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：南京市医学科技发展项目(YKK16242)

摘　　要：目的探讨腹腔镜下经阴道子宫全切术与传统子宫全切术联合同期阴道前后壁修补术在合并压力性尿失禁重度子宫脱垂老年患者的临床效果,并对远期预后进行比较。方法前瞻性招募2017年1月至2020年7月在泰康仙林鼓楼医院妇科门诊、住院部就诊的合并压力性尿失禁重度子宫脱垂老年患者,采用计算机随机数表法将研究对象分为对照组(n=40)及观察组(n=40)。观察组给予腹腔镜下经阴道子宫全切术联合同期阴道前后壁修补术,对照组给予传统子宫全切术联合同期阴道前后壁修补术。对比2组患者的手术耗时、失血量、肛门排气时间、总住院时间、总医疗费用、自感疼痛持续时间、术后12 h患者的疼痛程度、术后并发症指标。随访2年,对比2组术后2年内盆腔器官脱垂率,尿失禁影响问卷简版(IIQ-7)评分评估术后压力性尿失禁程度。结果观察组手术耗时、失血量、肛门排气时间、总住院时间均低于对照组,观察组总医疗费用高于对照组(P<0.05)。观察组自感疼痛持续时间、术后12 h疼痛视觉模拟评分(VAS)均低于对照组(P<0.05)。观察组术后并发症发生率低于对照组(P>0.05)。术后2年内观察组IIQ-7评分显著低于对照组,差异有统计学意义(P<0.05)。2组盆腔脏器脱垂复发率差异无统计学意义(P>0.05)。结论使用腹腔镜辅助下经阴道子宫全切术,可有效改善子宫脱垂手术操作的效果及安全性,缩短手术耗时,减少术中失血量,促进术后恢复,减轻术后疼痛程度,改善压力性尿失禁症状。Objective To investigate the clinical effect of laparoscopic transvaginal hysterectomy and traditional hysterectomy combined with anterior and posterior vaginal wall repair in elderly patients with severe uterine prolapse complicated with stress urinary incontinence,and to compare the long-term prognosis.Methods From January 2017 to July 2020,elderly patients with severe uterine prolapse complicated with stress urinary incontinence were prospectively recruited from the gynecological clinic and inpatient department of Taikang Xianlin Drum Tower Hospital.The subjects were divided into control group(n=40)and observation group(n=40)by computer random number table method.The observation group was given laparoscopic transvaginal total hysterectomy combined with simultaneous anterior and posterior vaginal wall repair,and the control group was given traditional total hysterectomy combined with simultaneous anterior and posterior vaginal wall repair.The operation time,blood loss,anal exhaust time,total hospitalization time,total medical expenses,self-perceived pain duration,pain severity 12 h after surgery,and postoperative complications of the two groups were compared.After two years of follow-up,the pelvic organ prolapse rate and the degree of stress urinary incontinence by incontinence impact questionnaire short form(IIQ-7)were compared between the two groups within 2 years after operation.Results The operation time,blood loss,anal exhaust time and total hospitalization time of the observation group were lower than those of the control group,and the total medical cost of the observation group was higher than that of the control group(P<0.05).The duration of self-perceived pain and visual analogue scale(VAS)score at 12 h after operation in the observation group were lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P>0.05).The IIQ-7 scores in the observation group were significantly lower than those in the control

关 键 词：腹腔镜 经阴道子宫全切术 老年人 子宫脱垂 尿失禁 压力性 

分 类 号：R713[医药卫生—妇产科学]