经阴道高位骶韧带悬吊术联合自体组织修复治疗重度盆腔器官脱垂的近期疗效  

Short-term effect of transvaginal high uterosacral ligament suspension combined with autologous tissue repair in the treatment of severe pelvic organ prolapse

作　　者：林宏镖 徐颖[1] 李迎[1] 陈贤璟[1] 王琪 林超琴[1] LIN Hong-biao;XU Ying;LI Ying;CHEN Xian-jing;WANG Qi;LIN Chao-qin(Fujian Maternity and Child Health Hospital,Fuzhou City,Fujian Province,350001,China)

机构地区：[1]福建省妇幼保健院妇六科,福建福州350001

出　　处：《蛇志》2021年第2期150-153,共4页Journal of Snake

基　　金：福建省妇幼保健院科技创新启动基金(YCXZ 18-22)。

摘　　要：目的探讨经阴道高位骶韧带悬吊术(HUS)联合自体组织修补手术治疗重度盆腔器官脱垂(POP)的疗效。方法回顾性分析2019年1~12月在我院行经阴道高位骶韧带悬吊术为主的自体组织修补手术治疗的重度盆腔器官脱垂患者31例的临床资料,分析围术期指标并评价手术安全性,并于术后第3、6、12个月采用国际尿控协会制定的盆腔器官脱垂定量(POP-Q)分度法进行客观评价,主观疗效采用患者全身状况改善问卷(PGI-I)、盆底功能障碍问卷简表(PFDI-20)、盆底功能影响问卷简表(PFIQ-7),性生活质量评价采用盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)进行评价。结果31例患者成功完成经阴道高位骶韧带悬吊术,7例因视野暴露困难经阴道腹腔镜辅助下完成,其中同时行子宫切除10例,阴道前壁修补26例,阴道后壁修补18例,会阴体成形20例。术中行膀胱镜检查,均无膀胱、输尿管损伤。手术时间(2.45±0.80)h,术中出血(42.19±70.12)ml,术后留置尿管时间(4.63±1.20)d,术后住院时间(7.25±2.18)d。术后随访12个月,除阴道总长度外,其余POP-Q测量值与术前比较差异均有统计学意义(均P<0.05)。术后患者的盆腔器官脱垂症状(如阴道膨出或下腹坠胀感)均有明显改善,总体主观满意(PGI-I问卷)患者26例(83.87%);PFDI-20评分由术前的(50.05±22.75)分降至术后的(13.84±6.46)分,差异有统计学意义(P<0.05);PFIQ-7评分由术前的(50.00±26.77)分降至术后的(11.01±5.32)分,差异有统计学意义(P<0.05);PISQ-12评分由术前的(21.50±8.12)分降至术后(12.00±4.36)分。结论经阴道高位骶韧带悬吊术联合自体组织修复治疗重度盆腔器官脱垂的成功率高,是一种安全、经济、微创的治疗方法,值得临床应用。Objective To study the efficacy of transvaginal high Uterosacral ligament suspension(HUS)combined with autologous tissue repair in the treatment of moderate to severe pelvic organ prolapse(POP).Methods The research object was a retrospective analysis of 31 cases of pelvic organ prolapse treated with autologous tissue repair surgery,mainly high Uterosacral ligament suspension,in the Fujian Provincial Maternity and Child Health Hospital from January 2019 to December 2019.Using pelvic organ prolapse quantitative(POP-Q)indexing method,31 cases of uterine prolapse were of grade III and IV,with an average age of(60.69±6.36)years.Follow-up at the 3 rd,6 th,and 12 th month after surgery,objective.The evaluation uses POP-Q,and the subjective efficacy uses the Patient General Condition Improvement Questionnaire(PGI-I),Pelvic Floor Impact Questionnaire Short Form(full English name,PFDI-20),and Pelvic Floor Impact Questionnaire Short Form 7,PFIQ-7),the quality of sexual life was evaluated using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ-12).Results All 31 cases successfully completed transvaginal high Uterosacral ligament sling,7 cases were completed with the aid of transvaginal laparoscopy due to difficulty in visual field exposure,including 10 cases of hysterectomy,26 cases of vaginal anterior wall repair,and posterior vaginal wall repair 18 cases,20 cases of perineal body shaping.Cystoscopy was performed on all patients during the operation,and there was no bladder or ureter injury.The total operation time was(2.45±0.80)h,intraoperative bleeding(42.19±70.12)ml,postoperative indwelling catheter time(4.63±1.20)d,postoperative hospital stay(7.25±2.18)d.The postoperative follow-up was 12 months to 18 months.Except for the total length of the vagina,the other POP-Q measurements had statistically significant differences(P<0.05 for each).Symptoms of pelvic organ prolapse(such as vaginal bulging or lower abdomen Distension)have been significantly improved.The overall subjective satisfaction(PGI-

关 键 词：盆腔器官脱垂 手术治疗 经阴道高位骶韧带悬吊术 自体组织修补 疗效 

分 类 号：R711.2[医药卫生—妇产科学]