经阴道高位骶韧带悬吊联合改良曼氏手术治疗年轻子宫脱垂的疗效  

Efficacy analysis of transvaginal high uterosacral ligament suspension combined with modified Manchester surgery in the treatment of young patients with uterine prolapse

作　　者：王琪 林超琴[1] 徐颖[1] 陈贤璟[1] 李迎[1] WANG Qi;LIN Chao-qin;XU Ying;CHEN Xian-jing;LI Ying(Department of Pelvic Floor Dysfunction,Affiliated Hospital of Fujian Medical University,Fujian Maternal and Child Health Care Hospital,Fuzhou 350001,Fujian,China)

机构地区：[1]福建省妇幼保健院盆底专科,福建福州350001

出　　处：《广东医学》2022年第1期75-79,共5页Guangdong Medical Journal

基　　金：福建省妇幼保健院科技创新启动基金(妇幼YCXZ18-22)。

摘　　要：目的探讨经阴道高位骶韧带悬吊联合改良曼氏手术治疗年轻患者子宫脱垂的临床疗效。方法回顾性分析因POP-Q分期Ⅱ~Ⅲ期子宫脱垂接受手术治疗的78例患者的临床资料,依据所行手术类型分为两组。其中38例行经阴道高位骶韧带悬吊联合改良曼氏手术为观察组,年龄(39.67±4.27)岁。40例单纯行改良曼氏手术为对照组,年龄(40.80±3.21)岁。术后随访采用盆底障碍影响简易问卷(PFIQ-7)、盆底不适调查表简表(PFDI-20)及盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)评价患者主观满意度及性生活质量,以POP-Q评分评价客观疗效。结果两组患者术中出血量、术后24 h VAS评分、术后排气时间及术后住院时间相比较,差异无统计学意义(P>0.05)。观察组手术时间较对照组长[(89.29±15.13)min vs.(71.55±13.93)min,P<0.05],随访时间为15~36个月(中位时间20个月)。两组患者术后POP-Q各指示点及PFIQ-7、PFDI-20、PISQ-12评分均较术前明显改善(P<0.05),术后12个月PFIQ-7评分观察组为(10.67±2.43)分,对照组为(12.75±2.86)分,差异有统计学意义(P<0.05);PFDI-20评分观察组为(14.78±6.33)分,对照组为(21.10±7.52)分,差异有统计学意义(P<0.05);PISQ-12评分观察组为(39.06±2.92)分,对照组为(37.10±2.63)分,差异有统计学意义(P<0.05)。随访期内对照组复发4例(4/40),复发率高于观察组(3/38),但差异无统计学意义(P>0.05)。结论经阴道高位骶韧带悬吊联合改良曼氏手术治疗POP-Q分期Ⅱ~Ⅲ期的子宫脱垂患者近期疗效显著,与单纯改良曼氏手术相比,更有助于提示患者生活质量。Objective To investigate the clinical effect of transvaginal high uterosacral ligament suspension(VHUS)combined with modified Manchester surgery in the treatment of young patients with uterine prolapse.Methods Seventy-eight patients with uterine prolapsed StageⅡ-Ⅲwere retrospectively analyzed and were divided into two groups depending on the surgical styles.Thirty-eight patients who underwent VHUS combined with modified Manchester surgery were enrolled into the study group,with the mean age of(39.67±4.27)years old;and 40 patients who underwent modified Manchester surgery were enrolled in the control group,with the mean age of(40.80±3.21)years old.During postoperative follow-up,questionnaires included Pelvic Floor Impact Questionnaire(PFIQ-7),Pelvic floor Distress Inventory-short Form(PFDI-20)and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire Short Form(PISQ-12)were used to evaluate the subjective satisfaction and sexual life quality;and the objective efficacy was evaluated by pelvic organ prolapse quantitation(POP-Q)stage.Results There was no significant difference in the intraoperative blood loss,postoperative VAS score,postoperative exhaust time or postoperative hospital stay between the two groups(P>0.05).The follow-up period was 15-36 months(median time was 20 months).Postoperative POP-Q indicator points and PFIQ-7,PFDI-20 and PISQ-12 scores in both groups were significantly improved compared with those before surgery(P<0.05).Twelve months after surgery,PFIQ-7 scores in the study group were 10.67±2.43,and that in the control group was 12.75±2.86,the difference was statistically significant(P<0.05).PFDI-20 scores in the study group were 14.78±6.33 and that in the control group was 21.10±7.52,the difference was statistically significant(P<0.05).PISQ-12 score in the study group were 39.06±2.92,and that in the control group was 37.10±2.63,the difference was statistically significant(P<0.05).During the follow-up period,4 cases(4/40)recurred in the control group,and the recurre

关 键 词：高位骶韧带悬吊术 改良曼氏手术 子宫脱垂 

分 类 号：R713.4[医药卫生—妇产科学] R711.23[医药卫生—临床医学]