前盆底重建术联合骶棘韧带固定术治疗盆腔脏器脱垂患者的临床观察  

Clinical observation of anterior pelvic floor reconstruction combined with sacrospinous ligament fixation in the treatment of pelvic organ prolapse

作　　者：杜贵强 舒慧敏 戴志远 DU Gui-qiang;SHU Hui-min;DAI Zhi-yuan(Department of Obstetrics and Gynecology,Shanghai First Maternal and Infant Hospital,Tongji University School of Medicine,Shanghai 201204,China.)

机构地区：[1]同济大学附属第一妇婴保健院妇产科,上海201204

出　　处：《临床和实验医学杂志》2020年第16期1752-1757,共6页Journal of Clinical and Experimental Medicine

基　　金：上海市科学技术委员会基金项目(编号:18411963900)。

摘　　要：目的探讨前盆底重建术联合骶棘韧带固定术治疗盆腔脏器脱垂患者的临床效果。方法回顾性选取2012年7月至2017年10月同济大学附属第一妇婴保健院收治的女性盆腔脏器脱垂的患者107例。所有患者的脱垂以前盆腔为主,无严重中盆腔脱垂(POP-Q评分分期,阴道前壁脱垂Ⅱ~Ⅲ度,“D”点达坐骨棘水平以上)。将107例患者按照手术方式分为两组(骶棘韧带组及桥式组)。其中骶棘韧带组52例,行前盆底重建及骶棘韧带固定术,桥式组55例,行前盆底重建及桥式修补术。术后随访24个月。分析手术时间、术中出血量、住院时间、手术前后POP-Q各指示点位置变化、客观治愈率、复发率、主观治愈率、生活质量和性生活质量变化以及并发症情况。结果骶棘韧带组患者较桥式组手术时间及住院时间更长、术中出血量更多,差异具有统计学意义(P<0.05)。骶棘韧带组及桥式组患者的手术成功率均为100%。术后24个月骶棘韧带组前盆腔(Aa点、Ba点)、中盆腔(C点、D点)及后盆腔(Ap点、Bp点)指示点数值均较术前明显减小(P<0.05);桥式组前盆腔及后盆腔指示点数值较术前明显减小(P<0.05),中盆腔指示点数值较术前无明显差异(P>0.05)。两组间比较,术后24个月骶棘韧带组中盆腔指示点数值明显较桥式组明显更小(P<0.05),前盆腔及后盆腔指示点数值无明显差异(P>0.05)。术后24个月,骶棘韧带组主观治愈率为96.15%,桥式组主观治愈率为96.36%,两组患者的一般生活质量较术前均有明显提高(P<0.05),两组间术后生活质量比较无明显差异(P>0.05)。两组患者的性生活质量均较术前有明显提高(P<0.05),桥式组术后性生活质量比较骶棘韧带组明显更高(P<0.05)。骶棘韧带组和桥式组患者术后24个月的中盆腔复发率分别为1.92%及5.45%,差异无统计学意义(P>0.05);总体复发率分别为7.69%及10.91%,差异无统计学意义(P>0.05);客观治愈率�Objective To investigate the clinical effect of anterior pelvic floor reconstruction combined with sacrospinal ligament fixation in the treatment of pelvic organ prolapse.Methods A retrospective study was conducted to select 107 female patients with pelvic organ prolapse admitted to Shanghai First Maternal and Infant Hospital from July 2012 to October 2017.All patients had mainly anterior pelvic organ prolapse,without obvious middle pelvic organ prolapse(with anterior vaginal wall prolapseⅡ~Ⅲdegrees by POP-Q stage and"D"point of ischial spine level above).The 107 patients were divided into 2 groups(the sacrospinous ligament group and the"bridge"group)according to the surgical methods.Among them,52 patients in the sacrospinous ligament group underwent anterior pelvic floor reconstruction and sacrospinous ligament fixation,while 55 patients in the"bridge"group underwent anterior pelvic floor reconstruction and bridge repair in the posterior vaginal walls.Postoperative follow-up was 24 months.The operative time,intraoperative blood loss,length of stay,changes in the position of each indicator point of POP-Q stage before and after the operation,objective cure rate,recurrence rate,subjective cure rate,changes in quality of life and sexual life and complications were analyzed.Results Compared with the"bridge"group,the patients in the sacrospinous ligament group had longer operation time,longer hospitalization time and more intraoperative blood loss(P<0.05).The success rate of surgery in both groups was 100%.In the sacrospinous ligament group,the index values of anterior pelvic cavity(Aa point,Ba point),middle pelvic cavity(C point,D point)and posterior pelvic cavity(Ap point,Bp point)were significantly reduced compared with those before the surgery(P<0.05).The value of the indicator points in the anterior and posterior pelvic cavity of the"bridge"group decreased significantly compared with that before the operation(P<0.05),while the value of the indicator points in the middle pelvic cavity showed no significant dif

关 键 词：盆腔脏器脱垂 前盆底重建术 骶棘韧带固定术 阴道后壁桥式修补术 

分 类 号：R713[医药卫生—妇产科学]