不同手术方式治疗子宫脱垂患者的临床疗效  

Clinical effect of different surgical methods in treating patients with uterine prolapse

作　　者：邱建[1] 姚国荣[1] 曹明月[1] 朱逢佳 黄筱竑[1] QIU Jian;YAO Guo-Rong;CAO Ming-Yue(Department of Obstetrics and Gynaecology,Huzhou Central Hospital,Affiliated Central Hospital Huzhou University,Huzhou,Zhejiang 313000,China)

机构地区：[1]湖州市中心医院妇产科湖州市师范学院附属中心医院妇产科,浙江湖州313000

出　　处：《中国妇幼保健》2022年第1期6-11,共6页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科技计划项目(2019ZH043)。

摘　　要：目的探讨不同手术方式治疗子宫脱垂患者的临床效果。方法选择2014年1月—2016年12月在该院就诊的子宫脱垂患者为研究对象,分别采用不同的手术方式:阴式子宫切除术(组1)、阴式子宫切除术+阴道残端高位骶韧带悬吊术(组2)、腹腔镜全子宫切除+阴道残端高位骶韧带联合圆韧带悬吊术(组3),对比分析3组一般临床特征、手术情况、生活质量、性生活质量以及术后复发情况。结果3组患者在年龄、孕产次、阴道分娩次数、体质指数、POP-Q分期、合并阴道壁脱垂情况、术中出血量、住院时间及术后随访时间等方面差异均无统计学意义(均P>0.05),组1的手术时间及手术费用明显少于组2及组3,差异有统计学意义(P<0.05);而组1中的所有患者在行阴式子宫切除的同时均行阴道壁修补术,组2中有87.9%及组3中有66.0%的患者需同时行阴道壁修补术,差异有统计学意义(P<0.05);治疗后,组2、组3的阴道深度均明显长于组1,差异有统计学意义(P<0.05);治疗后组2术后总的并发症发生率明显高于组1及组3,差异有统计学意义(P=0.020);3组患者术后盆底障碍影响简易问卷(PFIQ-7)评分均低于术前,且组2、组3术后的评分明显低于组1,差异有统计学意义(P=0.003);3组术后性生活质量问卷(PISQ-12)评分均高于术前,以组3改善最为明显,差异有统计学意义(P<0.05)。术后随访过程中组2、组3复发率分别为6.9%,6.0%,低于组1的15.7%,但差异无统计学意义(P=0.111)。结论对于子宫脱垂患者,相比于传统阴式子宫切除术,采用阴式子宫切除联合阴道残端高位骶韧带悬吊术及腹腔镜子宫切除+高位骶韧带联合圆韧带悬吊术治疗效果显著,其中腹腔镜子宫切除+高位骶韧带联合圆韧带悬吊术具有并发症少、复发率低等优点,能有效改善患者生活质量,具有较好的远期效果。Objective To explore the clinical effects of different surgical methods for patients with uterine prolapse.Methods Patients with uterine prolapse who were treated in our hospital from January 2014 to December 2016 were collected.Surgical methods were used as follow:Vaginal hysterectomy(group 1),Vaginal hysterectomy combined with high uterosacral ligament suspension(group 2),Laparoscopic hysterectomy and high uterosacral ligament combined with round ligament suspension(group 3),comparative analysis of general clinical characteristics,surgical conditions,quality of life and sexual life as well as recurrence were carried out.Results There were no significant differences among these three groups in terms of age,gravidity,parity,vaginal births,body mass index,POP-Q staging,vaginal wall prolapse,intraoperative blood loss,length of hospital stay,and postoperative follow-up time(P>0.05).The operation time and the hospitalization expenses of group 1 were significantly lower than that of group 2 and group 3,the differences were statistically significant(P<0.05).The proportion of patients who underwent vaginal wall repair in group 1 was 100%,which was significantly higher than that of group 2 and group 3(88.7%,66.0%,P<0.05);after treatment,the vaginal depth of groups 2 and group 3 was significantly longer than that of group 1,and the difference was statistically significant(P<0.05);the complication rate of group 2 after treatment was significantly higher than that of group 1 and group 3,the difference was statistically significant(P=0.020);the scores of simple questionnaire on the effects of pelvic floor disorders(PFIQ-7)of these three groups of patients after treatment were significantly lower than that of pretreatment,and the scores of groups 2 and group 3 were significantly lower than that of group 1,the difference was statistically significant(P=0.003).The scores of the three groups for sexual quality of life questionnaire(PISQ-12)were significantly higher than that of pretreatment,of which group 3 showed the most obvio

关 键 词：子宫脱垂 阴式子宫切除 高位骶韧带悬吊术 腹腔镜子宫切除 腹腔镜高位骶韧带悬吊术 临床效果 

分 类 号：R714.6[医药卫生—妇产科学]