3种不同术式治疗重度盆腔器官脱垂的临床观察  

Clinical observation on three different surgical methods in treatment of severe pelvic organ prolapse

作　　者：易思捷 熊员焕[2] 

机构地区：[1]南昌大学研究生院,江西南昌330006 [2]江西省人民医院妇产科

出　　处：《中国妇幼保健》2015年第16期2579-2582,共4页Maternal and Child Health Care of China

基　　金：江西省卫生厅科技计划〔20141015〕

摘　　要：目的:比较经阴道骶棘韧带悬吊术(VSSLF)、全盆底重建术、经阴道全子宫切除+阴道前或(和)后壁修补术3种手术对重度盆腔器官脱垂(POP)的临床疗效,探讨VSSLF的临床应用价值。方法:选择盆腔器官脱垂POP-Q评分为Ⅲ、Ⅳ期且要求手术治疗的患者90例,分别采取VSSLF(A组,30例)、全盆底重建术(B组,30例)、经阴道全子宫切除+阴道前和(或)后壁修补术(C组,30例),对3组的术中及术后各项指标、疗效、随访性生活满意度及生活质量进行对比。结果:A组手术时间、术中出血量少于B组和C组(P<0.05);3组术中均无并发症;3组术后病率、住院时间等方面无明显差异(P>0.05);A组的手术费用与C组相近(P>0.05),但低于B组(P<0.01);A组术后6个月阴道深度大于B组和C组(P<0.05);3组术后3个月Ba、Bp、C点POP-Q评分均较术前明显改善(P<0.05),其中A组较B组和C组两组变化更大(P<0.05);A组与B组术后2年性生活满意度及生活质量相当(P>0.05),高于C组(P<0.05);A组的2年复发率与B组相当(P>0.05),但低于C组(P<0.05)。结论:VSSLF是一种手术时间短、损伤小、出血量少、费用低、不改变盆底解剖结构及功能的微创手术,值得临床推广。Objective： To compare the clinical effects of transvaginal sacrospinous ligament fixation （VSSLF）, reconstruction of whole pelvic floor, transvaginal hysterectomy combined with vaginal anterior and posterior wall colporrhaphy in treatment of severe pelvic or- gan prolapse （POP）, explore the clinical application value of VSSLF. Methods： Ninety POP patients of stage Ⅲ-Ⅳ were selected and treated by surgery： 30 patients in group A were treated by VSSLF, 30 patients in group B were treated by reconstruction of whole pelvic floor, 30 patients in group C were treated by transvaginal hysterectomy combined with vaginal anterior and posterior wall colporrhaphy. The intraop- erative and postoperative indexes, curative effects, satisfaction degrees of sexual life, and life quality in the three groups were compared. Re- stilts： The operation time and the amount of blood loss during operation in group A were statistically significantly less than those in group B and group C （ P〈0. 05） ; no intraoperative complication occurred in the three groups; there was no statistically significant difference in post- operative morbidity and hospitalization time among the three groups （ P〉0. 05 ） ; there was no statistically significant difference in surgical cost between group A and group C （ P〉0. 05 ）, but the surgical cost in group A was statistically significandy tower than that in group B （ P〈 0.01 ） ; depth of vagina at six months after operation in group A was statistically significantly deeper than those in group B and group C （P〈0. 05） ; POP-Q scores at Ba, Bp, and C points at three months after operation in the three groups were statistically significantly better than those before operation （P〈0. 05 ）, especially in group A （P〈0. 05 ） ; there was no statistically significant difference in the satisfaction degree of sexual life and life quality at two years after operation between group A and group B （ P〉0. 05 ）, but the above-mentioned indexes in group A and grou

关 键 词：盆腔器官脱垂 经阴道骶棘韧带悬吊术 全盆底重建术 经阴道全子宫切除+阴道前或(和)后壁修补术 

分 类 号：R711.2[医药卫生—妇产科学]