腹腔镜阴道/子宫骶骨固定术疗效及术后性功能的评价  

Clinical Outcomes and Changes in Female Sexual Function After Repairment of Sacrocolpopexycolposacropexy/Sacrocopopexyhyterocolposacropexy

作　　者：张小红[1,2] 李秉枢[1] 吴德斌[1] 方桂[1] 闵洁[1] 刘成[1] 洪莎莎[1] 胡鸣[1] 杨青[1] 赵杨[1] 洪莉[1] 

机构地区：[1]武汉大学人民医院妇产科,湖北武汉430060 [2]湖北省汉川市人民医院妇产科,湖北汉川431600

出　　处：《武汉大学学报（医学版）》2015年第3期426-431,共6页Medical Journal of Wuhan University

基　　金：国家自然科学基金面上项目(编号:81270684);武汉市科技厅资助项目(编号:201260523178-1)

摘　　要：目的:探讨腹腔镜阴道/子宫骶骨固定术对盆腔器官脱垂(POP)患者的疗效及术后性功能的评价。方法:分析2008年1月至2012年12月间武汉大学人民医院经盆腔器官脱垂定量分度法(POP-Q)分度证实为Ⅲ度及以上POP、且已完成生育的52例患者,23例行腹腔镜阴道骶骨固定术(HY+CSP子宫切除),29例行子宫骶骨固定术(HSP子宫保留),分别在术后1,6,12个月以及此后每年1次随诊,应用POP-Q评估、尿失禁影响问卷(ⅡQ-7)、泌尿生殖系影响量表(UDI-6)、视觉模拟满意度评分法(VAS)评估患者术后疗效。采用女性性功能指标量表(FSFI)问卷调查,评估患者术前、术后1年性生活质量。结果:腹腔镜阴道/子宫骶骨固定术后以POP-QⅡ度为复发的客观标准,患者术前、术后进行POP-Q分度评估、UDI-6、IIQ-7问卷、VAS满意度评分比较差异有统计学意义(P<0.05)。子宫骶骨固定术及阴道骶骨固定术患者术前FSFI中位数得分相似,而手术前后FSFI评分差异有统计学意义(P<0.05),且术后子宫骶骨固定组的性欲望、性兴奋和高潮程度中位数得分明显高于阴道骶骨固定组。结论:阴道/子宫骶骨固定术是治疗盆腔器官脱垂疗效良好的手术方式之一,子宫骶骨固定术的子宫保留与患者术后性生活质量密切相关。Objective：To evaluate clinical and sexual outcomes of sacrocolpopexycolposacropexy/sacrocopopexyhysterocolposacropexy after pelvic organ prolapse（POP）repair.Methods：We retrospectively analyzed the clinical profiles of 52 women with severe POP who had already given birth and underwent sacrocolpopexycolposacropexy（HY ＋ CSY） or sacrocolpopexyhysterocolposacropexy（HSP）between January 2008 and December 2012.All patients were defined as Pelvic Organ Prolapse Quantification（POP-Q）stage Ⅲ.Follow-up was performed at end of 1,6,and 12 months,and then annually.All patients completed the Female Sexual Function Index（FSFI）questionnaire,before and after surgery,and completed the Urogenital Distress Inventory short form（UDI-6）and Incontinence Impact on Quality of Life short form（IIQ-7）questionnaires,and the satisfaction Visual Analogue Scale（VAS）.The postoperative sexual function was evaluated by the FSFI,and clinical outcomes were evaluated by the POP-Q,the UDI-6,theⅡQ-7,and the VAS.Results：Fifty-two patients were included：29cases underwent HSP and 23HY＋CSY.Based on stageⅡ of POP-Q as recurrence criteria,the anatomical success and patient satisfaction rates were significantly higher after surgery（P〈0.05）.Median pre-operative FSFI scores of the two groups were similar.Both groups（HSP and HY＋CSP）had significant improvement after surgery（P〈0.05）in total score.Furthermore,median post-operative scores of the desire,arousal and orgasm domains showed a significant improvement in the HSP group compared with the HY＋CSY group.Conclusion：Sacrocolpopexycolposacropexy/sacrocopopexyhysterocolposacropexy conferred satisfying long-term anatomic outcomes and uterus preservation is associated with a greater improvement in sexual function.

关 键 词：盆腔器官脱垂 性 腹腔镜检查 妇科外科手术 

分 类 号：R711.2[医药卫生—妇产科学]