经阴道改良盆底功能重建术中切除子宫与保留子宫的疗效比较  

Comparison of uterus conservation versus hysterectomy in transvaginal modified pelvic floor reconstruction

作　　者：刘增婷 潘珂[1] 曹莉莉[1] 王延洲[1] 雷玲[1] 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》2016年第11期1309-1312,共4页Journal of Third Military Medical University

摘　　要：目的比较经阴道改良盆底重建术中切除子宫与保留子宫的临床疗效及对患者生活质量的影响。方法收集2009-2013年在我院接受经阴道改良盆底重建术的患者临床资料,切除子宫组(concomitant hysterectomy group,CH)71例,保留子宫组(uterus conservation group,UC)53例。比较手术时间等围手术期参数;采用盆腔器官脱垂分度(POP-Q)评估患者术前的脱垂情况及术后的手术效果;以盆底疾病生活质量影响问卷(pelvic floor impact questionnaire-short form 7,PFIQ-7)、盆底功能障碍疾病相关问卷(pelvic floor distress inventory short form 20,PFDI-20)评价手术对患者生活质量的影响。结果两组患者手术时间、术中出血量、手术费用比较,差异有统计学意义(P<0.05)。两组患者术后的POP-Q值及POP-Q分期均较术前有明显改善;两组术后PFIQ-7和PFDI-20评分均较术前有显著降低(P<0.05),但两组术后以上参数比较差异无统计学意义(P>0.05)。术后患者有性生活的UC组9例和CH组8例;两组术后PISQ-12评分差异无统计学意义(P>0.05)。结论经阴道改良盆底功能重建术中选择保留子宫不影响手术疗效。Objective To evaluate and compare the clinical effects and quality-of-life outcomes of transvaginal modified floor reconstruction in combination with uterus conservation or hysterectomy in patients without a prior history of urogenital surgery. Methods Medical records of 124 patients,who underwent modified reconstructive pelvic surgery for pelvic organ prolapse（ POP） during January 2009 to December2013,were reviewed retrospectively,and the patients were divided into concomitant hysterectomy group（ CH group,n = 71） and uterus conservation group（ UC group）. The preoperative and postoperative effects were evaluated using objective POP quantification（ POP-Q）,and the perioperative parameters such as operation time were compared. The therapeutic effect and impact on quality-of-life were analyzed through scores of pelvic floor impact questionnaire-short form 7（ PFIQ-7）,pelvic floor distress inventory short form 20（ PFID-20） and pelvic organ prolapsed-urinary incontinence sexual questionnaire（ PISQ）. Results The average operation time,blood lost amount in operation and surgical cost had statistically significant differences between the CH group and the UC group（ P〈 0. 05）. All the POP-Q parameters and stages were significantly improved（ P〈 0. 05） in both groups after surgery. The scores of PFIQ-7 and PFDI-20 questionnaires were lower（ P〈 0. 05） after surgery,but the difference of the postoperative parameters between the UC group and the CH group was not statistically significant（ P〉 0. 05）. Nine patients in the UC group and eight patients in the CH group had the sexual life after surgery,but the difference of questionnaire of PISQ-12 was not statistically significant. Conclusion Uterus conservation in modified pelvic floor reconstruction has become a valid option.

关 键 词：盆底器官脱垂 改良盆底功能重建术 保留子宫 子宫切除术 

分 类 号：R713.42[医药卫生—妇产科学]