应用线性悬吊术治疗子宫脱垂  

Sling suspension： a new technique of treating uterine prolapse

作　　者：梁海燕[1] 陈纲[2] 于欢[1] 孙蔼萍 赵卫东[2] 凌斌[1] 

机构地区：[1]中日友好医院妇产科,北京100029 [2]安徽省立医院妇产科

出　　处：《中华医学杂志》2014年第21期1664-1666,共3页National Medical Journal of China

摘　　要：目的评价一种新的腹膜外线性悬吊子宫的手术方式的有效性。方法2011年9月至2012年12月，对中日友好医院及安徽省立医院21例POP—Q分类法子宫脱垂2级以上，中位数年龄59岁，同时有临床症状的患者进行了线性悬吊手术治疗。手术方法是在腹腔镜下用不可吸收线在腹膜外将子宫向腹前壁方向悬吊。统计手术时间，术中出血量，术后住院时间。随访时间为术后1、6及12个月，此后每年1次。比较手术前及术后6及12个月POP—Q和生活质量问卷评分，后者包括盆底疾病生活影响问卷7（PFIQ-7）和盆底功能障碍性疾病相关问卷20（PFDI一20）。手术成功的定义为主观治愈同时POP—Q评分正常范围。结果21例均成功完成手术。术中出血10（10～40）ml，手术时间30（25～90）min，术后住院时间1（1—5）d。随访20（12～26）个月。POP-Q中Ba和C点评分和生活质量评分在术后6、12个月时均较术前有显著改善。术后12个月时手术成功率100％。结论这种腹腔镜下线形悬吊手术安全有效，为治疗子宫脱垂提供了简单易行微创的新术式。Objective To report a novel surgical technique of laparoscopic extraperitoneal sling suspension for uterine prolapse and evaluate its efficacy. Methods A total of 21 consecutive patients of symptomatic uterovaginal prolapse with POP-Q （pelvic organ prolapse quantification system） stage ≥ 2 and aged 59 （42 -76） years were enrolled for this procedure between September 2011 and December 2012. In brief, uterus was suspended to anterior abdominal wall fascia using an inelastic nonabsorable mesh extraperitoneally under laparoseopic guidance. The outcomes of interest included total operative duration, estimated blood loss, surgical length of stay POP-Q score change and quality of life questionnaire in pelvic floor distress inventor [ PFDI-20 ] and pelvic floor impact questionnaire [ PFIQ-7 ]. Follow-ups were scheduled at 1, 6 and 12 months and then annually. Comparisons were made between at preoperation and 6 and 12 months. The surgical success was defined as both subjective cure and significant improvement of POP-Q. Results This procedure was performed successfully in all patients. The estimated blood loss 10 （10-40） ml, operative duration 30 （25 -90 ） minutes and postoperative hospital stay 1 （1 -5 ） day. There were no major intraoperative or postoperative complications. The median follow-up was 20 （12 -26） months. There were significant improvements in POP-Q measurements of Ba and C （P 〈0.01 ） and quality- of-life scores （P 〈0.01 ） at 6 and 12 months. The subjective cure rate was 100% and surgical success rate at 12 months 100%. Conclusion This new sling suspension technique for uterine prolapse is safe, well-tolerated and effective so that it offers a simple alternative of laparoscopic uterine suspension.

关 键 词：腹腔镜 微创手术 子宫脱垂 

分 类 号：R713.4[医药卫生—妇产科学]