腹腔镜阴道骶骨固定术治疗盆腔脏器脱垂合并压力性尿失禁的疗效评价  

Efficacy of laparoscopic sacrocolpopexy on pelvic organ prolapse concomitant with stress urinary incontinence

作　　者：曾薇薇[1] 苏圣梅 陈琛 袁桢[1] 黄山鹰[1] 刘剀[1] Wei-wei Zeng;Sheng-mei Su;Chen Chen;Zhen Yuan;Shan-ying Huang;Kai Liu(Department of Gynecology,Shenzhen Maternity&Child Health-care Hospital Affiliated to Southern Medical University,Shenzhen,Guangdong 518028,China)

机构地区：[1]南方医科大学附属深圳市妇幼保健院妇科,广东深圳518028

出　　处：《中国内镜杂志》2018年第9期48-53,共6页China Journal of Endoscopy

摘　　要：目的探讨腹腔镜阴道骶骨固定术(LSC)对盆腔脏器脱垂(POP)合并压力性尿失禁(SUI)患者的治疗效果。方法回顾性分析31例POP合并轻、中度SUI患者,比较患者LSC手术前后POP评价体系(POP-Q)各指示点、盆底功能问卷排尿不适量表(UDI-6)和尿失禁影响问卷简表(IIQ-7)问卷评分、盆底超声指标和尿动力学指标的变化情况。结果 31例患者均成功施行LSC,中位随访时间为22个月,术后随访均无失败或复发病例。手术前后POP-Q各指示点Aa、Ba、C、Ap、Bp点的位置得到显著改善(P<0.05)。POP客观治愈率100.00%。手术前后的UDI-6和IIQ-7问卷评分术后均较术前明显下降(P<0.05),提示术后生活质量明显改善。盆底超声提示术后膀胱颈移动度(BND)和膀胱后角(RVA)较术前明显减小(P<0.05),表明术后尿道高活动性降低。其中12例患者术后最大尿流率时逼尿肌压力、功能性尿道长度、最大尿道压及最大尿道闭合压较术前上升(P<0.05)。LSC术后SUI治愈率为82.76%。结论在LSC术后,SUI主观及客观指标均得到改善。因此,不建议在LSC同时对轻、中度SUI患者行预防性抗SUI手术。Objective To evaluate the clinical outcome of laparoscopic sacrocolpopexy(LSC)in pelvic organ prolapsed(POP)concomitant with stress urinary incontinence(SUI).Methods Among 31 POP cases concomitant with SUI(mild and moderate),the pelvic organ prolapsed quantitation(POP-Q)was used to evaluate the objective outcomes of POP.Pelvic ultrasonography,urodynamics investigation,urinary distress inventory(UDI-6)and incontinence impact questionnaire short form(IIQ-7)were used to evaluate the objective and subjective outcomes of SUI.Results All the 31 subjects were successfully performed LSC and the median follow-up time was 22 months without failure or relapse.Compared with the preoperative indicators,the postoperative POP-Q indication points of Aa,Ba,C,Ap,Bp improved significantly(P<0.05).The objective cure rate of POP was 100.00%.Mean score of UDI-6 and IIQ-7 decreased significantly(P<0.05),suggesting that life quality improved greatly.Additionally,pelvic ultrasonography showed postoperative bladder neck descent(BND)and retrovesical angle(RVA)were significantly reduced(P<0.05),indicating that postoperative urethral high activity decreased.Among all the subjects,postoperartive detrusor pressure at maximal urine flow rate(Pdet.at Qmax),functional urethral length(FUL),maximum urethral pressure(MUP)and maximum urethral closure pressure(MUCP)of 12 patients increased than that before surgery(P<0.05).In summary,the cure rate was of SUI after LSC 82.76%.Conclusions Subjective and objective indicators of SUI are improved after LSC.Thus,the anti-incontinence procedures are not necessary in POP patient concomitant with SUI(mild and moderate)undergoing LSC.

关 键 词：腹腔镜 阴道骶骨固定术 盆腔脏器脱垂 压力性尿失禁 疗效 

分 类 号：R711.2[医药卫生—妇产科学]