腹腔镜下全子宫切除加髂耻韧带悬吊术治疗中盆腔器官脱垂的疗效分析  

Efficacy of laparoscopic total hysterectomy with pectopexy in the treatment of middle pelvic organ prolapse

作　　者：芦珍珍 王璐 栗浩然 相元翠 李红娟 王雅莉 Lu Zhenzhen;Wang Lu;Li Haoran(Department of Obstetrics and Gynecology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000;Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000)

机构地区：[1]郑州大学第二附属医院妇产科,郑州450000 [2]郑州大学附属郑州中心医院妇产科,郑州450000

出　　处：《现代妇产科进展》2020年第7期522-526,530,共6页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨腹腔镜下髂耻韧带悬吊术治疗中盆腔器官脱垂(POP)的围术期、短期疗效及术后并发症。方法:选取2018年至2019年于郑州市中心医院妇科因POP-Q评分≥Ⅱ期的中盆腔脱垂为主行腹腔镜下全子宫切除加髂耻韧带悬吊术40例,比较术前及术后3月POP-Q评分、生活质量评分(PFDI-20与PFIQ-7),全身状况改善问卷(PGI-C)了解主观满意度评价短期疗效。结果:40例患者均成功完成手术,术中均无肠管、输尿管、膀胱、血管及神经损伤。住院期间1例(2.5%)出现无症状下肢肌间静脉血栓形成,经积极治疗后治愈。随访过程中2例(5%)出现阴道残端网片暴露,并于无菌状态下剪除暴露的网片;2例(5%)出现术后新发压力性尿失禁(SUI),均行盆底康复治疗后症状明显减轻;3例(7.5%)出现新发尿急症状;无一例发生排便障碍症状。术前及术后3月POP-Q评分差异为Aa点1.0(0.125,3.0)cm vs-2.5(-2.6,-2.0)cm,Ba点2.0(0.5,4.0)cm vs-2.45(-2.5,-2.0)cm,C点1.0(0.5,3.0)cm vs-5.0(-5.38,-4.13)cm,Ap点-1.0(-2.0,0.0)cm vs-2.5(-2.5,-2.0)cm,Bp点-1.0(-2.0,0.0)cm vs-2.5(-2.5,-2.0)cm,差异均有统计学意义(P<0.05);TVL6.0(5.63,7.0)cm vs 6.0(6.0,7.0)cm差异无统计学意义(P>0.05);术前及术后生活质量评分PFDI-20(64.62±17.65)vs(10.12±5.44)及PFIQ-7(69.86±16.55)vs(9.79±5.45),差异均有统计学意义(P<0.05),主观满意度为90%。结论:腹腔镜下髂耻韧带悬吊术是治疗中盆腔器官脱垂的新术式,具有手术时间短、术中并发症及术中出血量少等优势,但其术后可能出现新发尿失禁及阴道残端网片暴露等并发症。Objective:To evaluate perioperative period,the short-clinical effectiveness and postoperation complications of laparoscopic pectopexy for middle pelvic organ prolapse.Methods:40 patients who underwent laparoscopic total hysterectomy with pectopexy due to middle pelvic prolapse with POP-Q score above II was analyzed at Zhengzhou Central Hospital from 2018 to 2019.The short-term clinical efficacy were evaluated by comparing the POP-Q score,PFDI-20 and PFIQ-7 questionnaires for pelvic floor dysfunction before operation and 3 months after operation,and the overall condition improvement questionnaire to understand the subjective satisfaction.Results:The operations were successfully completed in the 40 patients.No injuries of rectum,urethra,bladder,great vessels and nerves occurred.One case(2.5%)of asymptomatic venous thrombosis in the lower extremity during the perioperative period,and was cured after active treatment.During the follow-up period,2 cases(5%)mesh erosion were occurred 2 months and 6 months after operation respectively,and the exposed mesh was cut off in a sterile state.2 de novo SUI cases(5%)were occurred and symptoms were obviously relieved after pelvic floor rehabilitation treatment.3 cases(7.5%)de novo urgency were occurred,no defecation disorders were recorded.There were significant differences in Aa[1.0(0.125,3.0)cm vs-2.5(-2.6,-2.0)cm],Ba[2.0(0.5,4.0)cm vs-2.45(-2.5,-2.0)cm],C[1.0(0.5,3.0)cm vs-5.0(-5.38,-4.13)cm],Ap[-1.0(-2.0,0.0)cm vs-2.5(-2.5,-2.0)cm],Bp[-1.0(-2.0,0.0)cm vs-2.5(-2.5,-2.0)cm]among the other indicators(P<0.05).There was no significant difference(P>0.05)between TVL[6.0(5.63,7.0)cm vs 6.0(6.0,7.0)cm].There were significant differences in PFDI-20[(64.62±17.65)vs(10.12±5.44)]and PFIQ-7[(69.86±16.55)vs(9.79±5.45)]scores before operation and 3 months after operation(P<0.05).Subjective satisfaction was 90%.Conclusion:Laparoscopic iliopectineal ligament suspension is a new method for the treatment of pelvic organ prolapse.It has the advantages of short operating time,less intraoperat

关 键 词：盆腔脏器脱垂 腹腔镜下髂耻韧带悬吊术 围术期 术后新发压力性尿失禁 网片暴露 短期疗效 

分 类 号：R713[医药卫生—妇产科学]