阴道前壁黏膜瓣尿道中段悬吊术配合术后盆底康复疗法治疗前盆腔器官脱垂合并张力性尿失禁的疗效分析  

Analysis of the efficacy of middle urethral suspension combined with postoperative pelvic floor rehabilitation therapy in the treatment of anterior pelvic organ prolapse with stress urinary incontinence

作　　者：周秀春[1] 钟小英[1] 黄佩宁 ZHOU Xiuchun;ZHONG Xiaoying;HUANG Peining(Department of Gynecology,Xinhui Maternity and Children's Hospital,Guangdong,Jiangmen 529100,China)

机构地区：[1]广东省江门市新会区妇幼保健院妇科,广东江门529100

出　　处：《中国医药科学》2020年第24期105-108,112,共5页China Medicine And Pharmacy

基　　金：广东省江门市第八批医疗卫生科技计划项目(2017A3022)。

摘　　要：目的探析阴道前壁黏膜瓣尿道中段悬吊术配合术后盆底康复疗法治疗前盆腔器官脱垂合并张力性尿失禁的疗效。方法采用前瞻性研究方法选取2015年10月~2017年9月本院收治的90例前盆腔器官脱垂合并张力性尿失禁患者作为本研究对象,按随机数字表法分成观察组(n=45)与对照组(n=45)。对照组行传统阴道前壁修补术治疗并配合术后盆底康复训练,观察组行阴道前壁黏膜瓣尿道中段悬吊术配合术后盆底康复疗法治疗,比较两组手术情况、住院时间、手术并发症、术后排尿情况、术后阴道残端愈合情况、术后盆底康复治疗率以及术后2年随访情况。结果两组手术时间、术中出血量、术后肛门排气时间、术后下床活动时间及住院时间比较,差异均无统计学意义(P>0.05);与对照组比较,观察组手术并发症总发生率更低,术后排尿治疗有效率、术后阴道残端愈合率、盆底康复治疗有效率及盆腔器官脱垂客观有效率均更高,差异有统计学意义(P<0.05)。结论对于前盆腔器官脱垂合并张力性尿失禁患者施行经阴道壁黏膜瓣尿道中段悬吊术配合术后盆底康复疗法,是一种较好的手术方式与术后预防锻炼方式,值得在基层医院临床推广运用。Objective To explore the efficacy of middle urethral suspension(MUS)combined with postoperative pelvic floor rehabilitation therapy in the treatment of anterior pelvic organ prolapse with stress urinary incontinence(SUI).Methods A total of 90 patients with anterior pelvic organ prolapse with SUI treated in our hospital from October 2015 to September 2017 were prospectively selected as the objects of this study.According to the method of random number table,the patients were divided into the observation group(n=45)and the control group(n=45).The control group was treated with traditional anterior vaginal wall repair combined with postoperative pelvic floor rehabilitation,and the observation group was treated with anterior vaginal wall mucosal flap urethral suspension combined with postoperative pelvic floor rehabilitation therapy.The operation conditions,hospitalization stay,surgical complications,postoperative urination,postoperative vaginal stump healing,postoperative pelvic floor rehabilitation rate,and 2-year follow-up were compared between two groups.Results There were no statistically significant differences between the two groups in operation time,intraoperative blood loss,postoperative anus exhaust time,postoperative time to get out of bed,and hospital stay(P>0.05).Compared with the control group,the overall incidence of complications was lower and the effective rate of postoperative urination treatment,the healing rate of postoperative vaginal stump,the effective rate of pelvic floor rehabilitation,and the objective response rate of pelvic organ prolapse were all higher in the observation group,and the difference was statistically significant(P<0.05).Conclusion MUS with transvaginal mucosal flap combined with postoperative pelvic floor rehabilitation therapy is a better way of surgery and postoperative preventive exercise for patients with anterior pelvic organ prolapse and SUI.It is worthy of popularization and application in grass-roots hospitals.

关 键 词：前盆腔器官脱垂 张力性尿失禁 阴道前壁黏膜瓣尿道中段悬吊术 术后盆底康复疗法 

分 类 号：R711.2[医药卫生—妇产科学] R711.59[医药卫生—临床医学]