单侧骶棘韧带固定术治疗盆腔器官脱垂  

Unilateral sacrospinous ligament fi xation in treatment of pelvic organ prolapse

作　　者：周宁[1] 赵恩峰[1] 张云[1] 

机构地区：[1]解放军总医院妇产科,北京100853

出　　处：《解放军医学院学报》2014年第3期221-223,285,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的：研究单侧骶棘韧带固定术（sacrospinous ligament fixation，SSLF））治疗盆腔脏器脱垂（pelvic organ prolapse，POP）的有效性及安全性。方法回顾性分析我院2005年12月-2012年12月妇产科就诊的80例严重盆腔脏器脱垂且接受单侧SSLF治疗的患者的临床资料，术后6周和6个月进行随访，效果评估包括标准化问卷以及特定部位的阴道检查，并进行POP-Q评分。结果完整随访70例，平均术后随访26.1个月，随访率为87.5%。平均手术时间52（46-110） min，平均失血量83（30-188） ml，平均住院日6.2 d，术后留置尿管平均2.5 d，术后病率17.5%（14/80）。3例（3.7%）盆腔右侧发生血肿，2例（2.8%）术后6个月时阴道穹窿复发。手术成功率85%（68/80）。11例（15.7%）有腰骶部、腹股沟或右侧腹部疼痛，6例（8.6%）伴有新发的压力性尿失禁，2例（2.8%）产生新发的急迫性尿失禁，5例（7.1%）发现缝合线阴道暴露。POP-Q的Aa、Ba、Ap、Bp和D项上，术前与术后差异有统计学意义（P＜0.01）。结论单侧SSLF是治疗盆腔脏器脱垂一种安全、经济有效的方法，尤其适合严重的阴道顶端合并前壁膨出以及POPⅠ、Ⅱ或Ⅲ期的子宫脱垂者，其主要并发症是腰骶部、臀部和腹股沟疼痛以及新发的压力性尿失禁。Objective To study the efficiency and safety of unilateral sacrospinous ligament fixation （SSLF） in treatment of pelvic organ prolapse （POP）. Methods Clinical data about 80 patients with severe POP who underwent unilateral SSLF in our department from December 2005 to December 2012 were retrospectively analyzed. The patients were followed up from 6th week and 6th month after operation and their POP-Q was scored according to the standard questionnaire investigation and site-specific vaginal examination. Results Seventy （87.5%） out of the 80 patients were followed up with a mean follow-up time of 26.1 months. The average operation time was 52 min, the average blood loss was 83 ml, the average hospital stay time was 6.2 days, the urinary catheter indwelling time was 2.5 days, and the postoperative morbidity was 17.5%. Hematoma was found in the right pelvic of 11 patients （15.7%）, vaginal vault prolapse in 2 patients （2.8%）, stress incontinence in 6 patients （8.6%）, urgent incontinence in 2 patients （2.8%）, and vaginal suture exposure in 5 patients（7.1%）. The Aa, Ba, Ap, Bp and D of POP-Q were significantly different before and after operation （P＆lt;0.01）. Conclusion Unilateral SSLF is a safe and effective procedure for POP, especially for stages 1-3 POP. Its main complications are lumbosacral, buttock and inguinal pain and stress incontinence.

关 键 词：经阴道单侧骶棘韧带固定术 子宫脱垂 阴道穹隆脱垂 并发症 

分 类 号：R713[医药卫生—妇产科学]