腹腔镜下子宫/阴道骶骨固定术与改良全盆底功能重建术治疗中盆腔缺陷的疗效比较  

Efficiency of laparoscopic sacral hysteropexy / sacrocolpopexy versus modified total vaginal mesh in treatment of uterus or vaginal vault prolapse

作　　者：潘珂[1] 曹莉莉[1] 王延洲[1] 杨铧琦 徐惠成[1] 

机构地区：[1]第三军医大学西南医院妇产科,重庆400038

出　　处：《第三军医大学学报》2015年第6期573-577,共5页Journal of Third Military Medical University

摘　　要：目的分析腹腔镜下子宫/阴道骶骨固定术与改良全盆底功能重建术治疗中盆腔缺陷所致的盆腔器官脱垂(pelvic organ prolapse,POP)的疗效比较。方法回顾性收集2008年1月至2012年12月在我院接受腹腔镜下子宫/阴道骶骨固定术(观察组,57例)和改良全盆底功能重建术(对照组,55例)的患者临床资料。随访利用盆腔器官脱垂定量(pelvic organ prolapse quantification POP-Q)评分法比较患者客观满意度;主观症状改善评分(patient global impression of change,PGI-C)比较主观满意度;比较手术时间和出血量等围手术期参数;术后比较并发症、再次手术率;利用盆底生活质量问卷(pelvic floor distress inventory-short form 20,PFDI-20;pelvic floor impact questionnaire 7,PFIQ-7)比较2组术前、术后生活质量评分。结果所有患者手术都有较好的结局。观察组与对照组相比,减少了出血量、留置尿管时间、术后住院时间。在平均42个月的随访中,主观满意度在观察组为57/57(100%),在对照组为51/55(92.73%)(P>0.05);客观满意度在观察组为45/57(78.95%),在对照组为38/55(69.09%)(P>0.05)。PGI-C评分在观察组显著优于对照组;PFDI-20、PFIQ-7问卷2组评分均较术前显著改善,但2组间并无显著差异;性生活质量问卷(pelvic organ prolapse/urinary incontinence sexual questionnaire-12,PISQ-12)评分在观察组术前及术后均优于对照组(P<0.01)。结论与改良全盆底功能重建术比较,腹腔镜子宫/阴道骶骨固定术可显著减少手术出血量、留置尿管时间和术后住院时间,有较好的主观症状改善。Objective To compare laparoscopic sacral hysteropexy/sacrocolpopexy with modified total vaginal mesh in the treatment of uterus or vaginal vault prolapse. Methods A retrospective cohort pilot study was carried out to comparing the efficiency of laparoscopic sacral hysteropexy/sacrocolpopexy （ n = 57, treatment group ） with that of modified total vaginal mesh （n = 55, control group ）. All these patients underwent the surgeries in our department from January 2008 to December 2012. Pelvic organ prolapse quantification （POP-Q） was used to evaluate the outcomes of objective satisfaction, and patient global impression of change （ PGI-C ） for the subjective satisfaction. Peri-operative blood loss and operative time, post-operative complications, and subsequent surgery were compared between the 2 groups. The quality of life was assessed by Pelvic Floor Distress Inventory-Short Form 20 （PFDI-20） and Pelvic Floor Impact Questionnaire 7 （PFIQ-7）. Results The POP-Q scores were significantly improved in both groups postoperatively. Meanwhile, the treatment group had less mean blood loss, shorter postoperative catheterization time and hospital stay compared with the control group. After a mean follow-up duration of 42 months, no significant difference was seen in the objective satisfaction rate （45/57 vs 38/55, 78.95% vs 69.09%, P 〉0.05） and the subjective satisfaction rate （57/57 vs 51/55, 100% vs 92.73%, P 〉 0.05） between the 2 groups. The postoperative PGI-C scores were significantly better in the treatment group than in the control group. The postoperative scores of PFDI-20 and PFIQ-7 were significantly improved. The preoperative and postoperative scores of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 （PISQ-12） were significantly better in the treatment group than in the control group （P 〈 0.01 ）. Conclusion Compared to modified total vaginal mesh, the laparoscopic sacral hysteropexy/sacrocolpopexy has the advantages of less blood loss, shorter postoperat

关 键 词：盆腔器官脱垂 腹腔镜 骶骨固定术 盆底功能重建 

分 类 号：R711.2[医药卫生—妇产科学] R713[医药卫生—临床医学]