腹腔镜下阴道骶骨固定术和经阴道使用网片盆底重建术在盆腔脏器脱垂治疗中的应用  

Application value of laparoscopic sacrocolpopexy and transvaginal mesh pelvic floor reconstruction in the treatment of pelvic organ prolapse

作　　者：陈礼全[1] 张晓薇[1] 林晓婷 王苏[1] 徐丽珍[1] CHEN Li-quan;ZHANG Xiao-wei;LIN Xiao-ting;WANG Su;XU Li-zhen(Pelvic Floor Center,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,Guangdong,CHINA)

机构地区：[1]广州医科大学附属第一医院盆底中心,广东广州510120

出　　处：《海南医学》2020年第18期2369-2372,共4页Hainan Medical Journal

基　　金：广东省医学科学技术研究基金(编号:B2020078)。

摘　　要：目的比较腹腔镜下阴道骶骨固定术(LSC)和经阴道使用网片(TVM)盆底重建术治疗盆腔脏器脱垂(POP)的临床疗效。方法回顾性分析2015年1~12月在广州医科大学附属第一医院盆底中心因POP行LSC的43例患者(LSC组)和行TVM的30例患者(TVM组)的临床资料。比较两组患者术中出血量、手术时间、留置尿管时间、术后住院时间和并发症发生情况;比较两组患者术前及术后6个月POP-Q各点测量值的变化,术后6个月采用盆底功能障碍问卷简要表-20(PFDI-20)评价生活质量、性生活质量问卷-12(PISQ-12)评价性生活质量。随访5年,记录远期并发症。结果两组患者术中出血量及术后住院天数比较差异均无统计学意义(P>0.05);LSC组患者的手术时间为(108.30±26.48)min,长于TVM组的(81.52±22.40)min,留置尿管时间为(2.56±0.82)d,明显短于TVM组的(3.23±1.01)d,差异均有统计学意义(P<0.05);术后6个月,两组患者POP-Q各点测量值均明显优于术前,差异均有统计学意义(P<0.05),但两组患者间比较差异无统计学意义(P>0.05);术后6个月,两组患者的PFIQ-20评分及PISQ-12评分均较术前显著改善,差异均有统计学意义(P<0.05),但LSC组患者术后PISQ-12评分为(79.76±15.26)分,明显高于TVM组的(60.16±11.42)分,差异有统计学意义(P<0.05);LSC组与TVM组患者术后发热发生率(2.3%vs 6.7%)、尿潴留发生率(9.3%vs 23.3%)、远期网片暴露发生率(2.3%vs 6.7%)比较差异均无统计学意义(P>0.05)。结论LSC和TVM均是治疗POP安全可靠的手术方式,LSC可以更好地改善患者的性生活质量,而TVM更适合于合并症多的老年患者,有利于缩短手术时间。Objective To compare the clinical efficacy of laparoscopic sacrocolpopexy fixation(LSC)and transvaginal mesh(TVM)pelvic floor reconstruction in the treatment of pelvic organ prolapse(POP).Methods The clinical data of 43 patients who underwent LSC and 30 patients underwent TVM in the First Affiliated Hospital of Guangzhou Medical University from January,2015 to December,2015 retrospectively analyzed.The intraoperative blood loss,operation time,indwelling catheter time,postoperative length of hospital stay,and complications were compared between the two groups.The changes of POP-Q were measured before and after 6 months,as well as PFDI-20,PISQ-12.The patients were followed up for 5 years and the long-term complications were recorded.Results There was no significant difference in blood loss and postoperative length of hospital stay between the two groups(P>0.05).The operation time of LSC group was(108.30±26.48)min,significantly longer than(81.52±22.40)min of TVM group,and the indwelling catheterization time was(2.56±0.82)d,significantly shorter than(3.23±1.01)d of TVM group(P<0.05).At 6 months after operation,the POP-Q values of the two groups were significantly better than those before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).At 6 months after operation,PFIQ-20 score and PISQ-12 score of the two groups were significantly improved(P<0.05),but the PISQ-12 score of the observation group was significantly higher than that of the control group:(79.76±15.26)points vs(60.16±11.42)points,P<0.05.There was no statistically significant difference(P>0.05)between LSC group and TVM group in the incidence of postoperative fever(2.3%vs 6.7%),urinary retention(9.3%vs 23.3%),and long-term net exposure(2.3%vs 6.7%).Conclusion LSC and TVM are safe and reliable surgical methods in the treatment of POP.LSC can better improve the quality of sexual life,and TVM is more suitable for elderly patients with more complications,which is conducive to shorten the operation time.

关 键 词：腹腔镜下阴道骶骨固定术 合成网片 盆底重建手术 并发症 生活质量 

分 类 号：R656[医药卫生—外科学]