髂耻韧带固定术纠正中盆腔缺陷的短期疗效评价  

Short-term efficacy of pectopexy in the treatment of middle pelvic defects

作　　者：陈飞 胡清[2] 刘冬霞[1] 王鲁文 李蕾[1] CHEN Fei;HU Qing;LIU Dong-xia;WANG Lu-wen;LI Lei(Department of Gvnecolog,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第三附属医院妇科,河南郑州450000 [2]中国医科大学附属盛京医院妇产科,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2019年第5期584-588,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：河南省卫健委联合共建项目(2018020180)

摘　　要：目的探讨髂耻韧带固定术治疗女性中盆腔缺陷的短期临床效果及安全性。方法收集2018年8月至2019年1月郑州大学第三附属医院和中国医科大学附属盛京医院妇科收治的32例因中盆腔器官脱垂定量分度法(POP-Q)评分≥Ⅱ度以上行髂耻韧带固定术患者的临床资料及随访信息,比较术前、术后1个月、术后3个月POP-Q的Aa、Ba、Ap、Bp、C、阴道总长度(TVL)各指示点位置评价客观临床疗效及盆底功能障碍性疾病症状问卷-20(PFDI-20)、盆底功能影响问卷简表(PFIQ-7)调查结果,评价该术式的主观生活质量情况。结果 32例患者完成髂耻韧带固定术时间52～75min,平均时间(59.22±29.21)min;术中出血量10～400mL,平均(83.75±78.89)mL;留置尿管天数1～5d,平均(2.24±0.83)d;残余尿量0～100mL,平均(32.79±29.81)mL;术后住院天数5～12d,平均(7.41±1.59)d。围手术期发生无症状性下肢静脉肌间静脉血栓1例(3.13%);坠积性肺炎1例(3.13%),以上经积极治疗后痊愈;其余患者围手术期均无并发症发生。随访期间出现盆腔不适感1例(3.13%),积极治疗后缓解,其余患者均无并发症发生。TVL术前与术后1个月、术后3个月对比[(7.94±0.84)cm vs.(7.73±0.60)cm vs.(7.61±0.58)cm],差异无统计学意义(P>0.05),其余各指示点Aa[(0.94±1.92)cm vs.-(2.81±0.40)cm vs.-(2.81±0.40)cm]、Ba[(2.28±2.62)cm vs.-(2.78±0.42)cm vs.-(2.78±0.42)cm]、Ap[-(2.00±1.41)cm vs.-(2.92±0.26)cm vs.-(2.91±0.30)cm]、Bp[-(0.91±2.78)cm vs.-(2.25±0.44)cm vs.-(2.25±0.44)cm]、C[(3.58±2.47)cm vs.-(7.72±0.58)cm vs.-(7.56±0.58)cm]差异均有统计学意义(P<0.05)。术前与术后3个月的PFIQ-7[(77.56±40.87)分vs.(7.87±10.92)分]、PFDI-20[(68.55±35.05)分vs.(7.66±6.50)分]评分比较,差异有统计学意义(P<0.05)。结论髂耻韧带固定术为治疗中盆腔缺陷提供新的思路和选择。但仍需大样本数据以及长期的随访来进一步观察远期疗效及并发症。Objective To explore the short-term clinical effect and safety of pectopexy in the treatment of female middle pelvic defects.Methods Collect the clinical data and follow-up information of 32 patients,who underwent pectopexy due to pelvic prolapse with POP-Q score aboveⅡ in the Third Affiliated Hospital of Zhengzhou University and Shengjing Hospital of China Medical University from August 2018 to January 2019.The objective clinical efficacy and the results of PFDI-20 and PFIQ-7 questionnaires for pelvic floor dysfunction were evaluated by comparing the locations of Aa,Ba,Ap,Bp,C and TVL indicators of quantitative pelvic organ prolapse(POP-Q)scale before operation,1 month and 3 months after operation.Results The 32 patients completed pectopexy in 52-75 minutes,the average time being(59.22 ± 29.21)minutes;intraoperative bleeding was 10-400 mL,the average being(83.75 ± 78.89)mL;indwelling catheter days were 1-5 days,the average being(2.24±0.83)days;residual urine was 0-100 mL,the average being(32.79±29.81)mL;postoperative hospitalization days were 5-12 days,the average being(7.41±1.59)days.There was 1 case(3.13%)of asymptomatic venous thrombosis in the lower extremity during the perioperative period and 1 case(3.13%)of hypostatic pneumonia,and they were cured after active treatment.No complications occurred in the otherpatients during the perioperative period.During the follow-up period,pelvic discomfort occurred in 1 case(3.13%),which was relieved after active treatment,andno complications occurred in the rest of the patients.There was no significant difference(P>0.05)between TVL preoperatively and postoperatively at 1 and 3 months[(7.94±0.84)cm vs.(7.73±0.60)cm vs.(7.61±0.58)cm].There were significant differences in Aa[(0.94±1.92)cm vs.-(2.81±0.40)cm vs.-(2.81±0.40)cm],Ba[(2.28±2.62)cm vs.-(2.78±0.42)cm vs.-(2.78±0.42)cm],Ap[-(2.00±1.41)cm vs.-(2.92±0.26)cm vs.-(2.91±0.30)cm],Bp[-(0.91±2.78)cm vs.-(2.25±0.44)cm vs.-(2.25±0.44)cm]and C[(3.58±2.47)cm vs.-(7.72±0.58)cm vs.-(7.56±0.58)cm]among

关 键 词：盆腔器官脱垂 髂耻韧带固定术 盆腔器官脱垂定量分度法 中盆腔缺陷 

分 类 号：R713[医药卫生—妇产科学]