三种手术治疗重度盆腔器官脱垂的疗效观察及其复发因素分析  

Comparison outcomes of three surgical procedures in treatment of severe pelvic organ prolapse and analysis of risk factors for genital prolapse recurrence

作　　者：胡昌东[1] 陈义松[1] 易晓芳[1] 丁景新[1] 冯炜炜[1] 尧良清[1] 黄健[1] 张英[1] 胡卫国[1] 朱芝玲[1] 华克勤[1] 

机构地区：[1]复旦大学附属妇产科医院妇科,上海200011

出　　处：《中华妇产科杂志》2011年第2期94-100,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：“十一五”国家科技支撑计划（2007BA104805）

摘　　要：目的比较“协和”全盆底重建手术、传统的阴式子宫全切除＋阴道前后壁修补术、阴式子宫全切除＋阴道前壁旁侧修补＋骶棘韧带固定＋阴道后壁“桥式”缝合＋会阴修补术等3种手术治疗重度盆腔器官脱垂的疗效，探讨“协和”全盆底重建手术的临床应用价值。方法选择重度盆腔器官脱垂，同时合并至少两个部位盆腔缺陷且需要手术的患者173例，86例（A组）采取植入聚丙烯网片材料，行“协和”全盆底重建手术，58例（B组）采取传统手术（阴式子宫全切除＋阴道前后壁修补术），29例（C组）采取阴式子宫全切除＋阴道前壁旁侧修补＋骶棘韧带固定＋阴道后壁“桥式”缝合＋会阴修补术。比较术前、术中及术后情况，以问卷评分随访术后性生活及生命质量满意度，并分析复发影响因素。结果（1）3组的手术时间、术中出血量、住院天数及术后病率，两两比较，差异均无统计学意义（P〉0．05）。（2）住院费用：A组为（11448±3049）元，B组为（7262±1607）元，C组（7140±1817）元，A组明显多于B、C两组（P〈0．05）。（3）术后阴道深度：A组[（7．5±1．4）cm]和C组[（7．1±0．6）cm]长于B组[（5．6±1．1）cm]，分别比较，差异均有统计学意义（P〈0．05）。阴道宽度：A组[（4．3±0．3）cm]宽于B组[（3．4±0．3）cm]、c组[（3．3±0．4）cm]，分别比较，差异均有统计学意义（P〈0．05）。（4）术后12个月复发：A组的复发率12．8％（11／86）与C组的17．2％（5／29）相仿（P〉0．05），明显低于B组的36．2％（21／58），分别比较，差异均有统计学意义（P〈0．05）。术后12个月内性生活保持率：A组为16．3％（14／86）明显高于B组的1．7％（1／58）和C组的0，分别比较，差异均有统计学意义（P〈0．05）。术后12个月生命质量改善效果：A组[（48±12）分]与C组[（53±16�Objective To investigate clinical significance and application of modified pelvic floor reconstruction developed by Peking Union Medical College Hospital （MPFR） in treatment of severe pelvic organ prolapse （POP） by comparing the effectiveness, quality of postoperative sexual life, life satisfaction and risk factors for POP recurrence with the following two surgical procedures： traditional total vaginal hysterectomy with anterior-posterior colporrhaphy （TVH-APC） and total vaginal hysterectomy with lateral colporrhaphy and sacrospinous ligament fixation and vaginal bridge repair and episiotomy （TVH-LC-SSLF- VBR-EP）. Methods Totally 173 patients with severe POP and at least two compartments defects of pelvic floor underwent surgeries in the study, 86 patients （group A） were treated by MPFR with polypropylene mesh application, 58 （group B） were treated by TVH-APC, and 29 patients （group C） were treated by TVH-LC-SSLF-VBR-EP. Peri-operative data and outcomes of postoperative courses at 6, 12, 18 months were collected and analyzed, in the meantime, the risk factors of recurrence were studied. Results （ 1 ） No statistical difference was observed among the above 3 groups in terms of length of operation, amount of blood loss, length of hospital stay, and morbidity after surgery （ P 〉 0. 05 ） . （ 2 ） Cost hospitalization was （ 11 448 ± 3049） Yuan in group A, which was significantly higher than （7262 ± 1607） Yuan in group B and （7140 ± 1817 ） Yuan in group C （P 〈 0. 05 ）. （3） The length of vaginal cuff of （7. 5 ± 1.4 ） cm in group A and （5.6 ± 1.1 ） cm in group C were significantly longer than （7.1 ± 0. 6 ） cm in group B （ P 〈 0. 05 ）. The width of vaginal cuff of （4. 3 ± 0. 3） cm in group A was larger than （3.4 ± 0. 3 ） cm in group B and （3.3 ± 0. 4） cm in group C （P 〈0. 05）. （4） The recurrence rate at 12 months after surgery was 12.8% （11/86） in group A, which was similar with 17.2% （5/29） in group C

关 键 词：子宫脱垂 妇科外科手术 治疗结果 复发 

分 类 号：R713[医药卫生—妇产科学]