改良经阴道子宫切除术联合阴道前后壁修补术治疗中老年肥胖患者中重度盆腔器官脱垂的效果观察  

Effect of Modified Transvaginal Hysterectomy Combined with Anterior and Posterior Vaginal Wall Repair in the Treatment of Moderate and Severe Pelvic Organ Prolapse in Middle-aged and Elderly Obese Patients

作　　者：王海波 李萍 胡晓丽 李苓妙 逯彩虹 籍霞 甄银枝 赵建龙 WANG Hai-bo;LI Ping;HU Xiao-li;LI Ling-miao;LU Cai-hong;JI Xia;ZHEN Yin-zhi;ZHAO Jian-long(Department of Obstetrics and Gynecology,Affiliated Hospital of Sergeant School of PLA Army Medical University,Shijiazhuang 050041,China;Medical Affairs Department,Affiliated Hospital of Sergeant School of PLA Army Medical University,Shijiazhuang 050041,China)

机构地区：[1]陆军军医大学士官学校附属医院妇产科,石家庄050041 [2]陆军军医大学士官学校附属医院医务科,石家庄050041

出　　处：《临床误诊误治》2020年第6期76-81,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题(20160249)。

摘　　要：目的探讨改良经阴道子宫切除术联合阴道前后壁修补术治疗中老年肥胖患者盆腔器官脱垂(pelvic organ prolapse,POP)的临床效果。方法选取2015年1月—2018年12月收治的83例行手术治疗的中老年肥胖中重度POP,根据手术治疗方式的不同,分为观察组(n=41)与对照组(n=42)。观察组采用改良经阴道子宫切除术联合阴道前后壁修补术,对照组采用传统经阴道子宫切除术联合阴道前后壁修补术。比较手术修补效果,记录围术期相关指标(手术时间、术中出血量、尿管留置时间、住院时间及术后病率),比较术后1个月POP-Q分度情况,观察术后3、6、12个月的病情复发情况,记录并发症发生情况。结果两组均按预定术式完成,手术修补成功率100%。两组尿管留置时间、住院时间及术后病率比较差异无统计学意义(P>0.05);与对照组比较,观察组手术时间缩短,术中出血量减少,差异有统计学意义(P<0.01)。两组术后1个月POP-Q分度比较差异无统计学意义(P>0.05)。两组术后3个月均无病情复发;术后6个月,观察组未发现病情复发,对照组病情复发1例(POP-Q分度Ⅱ度);术后12个月,观察组、对照组病情复发各2例,POP-Q分度均为Ⅱ度。两组病情复发总发生率比较差异无统计学意义(P>0.05)。两组术中无并发症发生。观察组术后2例、对照组术后3例发生会阴切口未一期愈合,经局部换药和(或)口服抗生素,于术后10~15 d完全愈合。结论改良经阴道子宫切除术联合阴道前后壁修补术治疗中老年肥胖中重度POP具有手术时间短、术中出血量少、创伤小等优势,且操作简单、易推广,适用于广大基层医院。Objective To investigate the clinical effect of modified transvaginal hysterectomy combined with anterior and posterior vaginal wall repair in the treatment of pelvic organ prolapse(POP)in middle-aged and elderly obese patients.Methods Eighty-three cases of middle-aged and elderly obese patients with moderate or severe POP treated by surgery from January 2015 to December 2018 were selected and divided into observation group(n=41)and control group(n=42)according to the different surgical treatments.The observation group was treated with modified transvaginal hysterectomy combined with anterior and posterior vaginal wall repair,while the control group was treated with traditional transvaginal hysterectomy combined with anterior and posterior vaginal wall repair.The surgical repair effect was compared,and the perioperative related indexes(duration of operation,intraoperative bleeding,duration of indwelling catheter,length of hospital stay and postoperative morbidity rate).The POP-Q scores at 1 month after operation were compared,the recurrence of the disease at 3,6 and 12 months after operation was observed,and the occurrence of complications was recorded.Results Two groups completed the scheduled operation,and the success rate of surgical repair was 100%.There was no significant difference in duration of indwelling catheter,length of hospital stay and postoperative morbidity rate(P>0.05).Compared with the control group,the duration of operation of the observation group was shortened,and intraoperative bleeding was reduced(P<0.01).There was no statistically significant difference in POP-Q degree at 1 month after operation between the two groups(P>0.05).There was no recurrence at 3 months after operation in both groups.At six-month follow-up after operation,no recurrence was found in the observation group,but recurrence was found in one patient in the control group(POP-Q scoreⅡdegree).At 12 months after operation,recurrence was found in two cases in the observation group and the control group respectively,and the P

关 键 词：盆腔器官脱垂 中老年 肥胖 子宫切除术 阴道式 阴道修补术 住院时间 疾病复发 

分 类 号：R711.2[医药卫生—妇产科学]