两种保留子宫的高位骶韧带悬吊术治疗中盆腔脱垂患者的临床疗效观察  

Effect observation of two different methods of high uterosacral ligament suspension with preservation of uterus on patients with middle pelvic organ prolapse

作　　者：朱丹 张凤格 王文慧 赵宁宁 ZHU Dan;ZHANG Fengge;WANG Wenhui;ZHAO Ningning(Department of Gynaecology,Shunyi Maternity and Childcare Hospital of Beijing,Beijing 101300,China)

机构地区：[1]北京市顺义区妇幼保健院妇科,北京101300

出　　处：《中国现代医生》2023年第18期61-64,共4页China Modern Doctor

摘　　要：目的 探讨经腹腔镜及经阴道腹膜外两种高位骶韧带悬吊术对年轻中盆腔脱垂患者的疗效。方法 回顾性分析2018年1月至2022年1月北京市顺义区妇幼保健院采用保留子宫的高位骶韧带悬吊术并完成系统随访的42例中青年中重度子宫脱垂患者的临床资料,根据手术方式分为经腹腔镜高位骶韧带悬吊术组(腹腔镜组,n=22)和经阴道腹膜外高位骶韧带悬吊术组(阴式组,n=20),两组均保留子宫,比较两组患者围手术期各项指标水平、评估术前及术后6个月时盆腔脏器脱垂情况,记录术后6个月盆底功能障碍性疾病症状问卷-20(pelvic floor dysfunction disease symptom questionnaire,PFDI-20)、盆腔器官脱垂/尿失禁性生活质量问卷-12(pelvic organ prolapse sexual quality questionnaire,PISQ-12)评价患者术后生活质量,以POP-Q评分评价客观疗效。结果 两组均未出现输尿管损伤,腹腔镜组较阴式组术中出血量少,恢复自主排尿、术后排气时间、术后住院时间短(P<0.05)。两组患者术后POP-Q各指标水平均优于术前(P<0.05),腹腔镜组C点指标优于阴式组(P<0.05)。两组患者术后PFDI-20评分、PISQ-12评分比较,差异无统计学意义(P>0.05),随诊6个月两组均无复发病例。结论 两种保留子宫的高位骶韧带悬吊术治疗年轻患者中盆腔脱垂安全有效,术后患者生活质量均有显著改善。经腹腔镜术式更有利于术后恢复,且短期悬吊效果优于经阴道腹膜外术式,长期效果尚需继续随访评价。Objective To investigate the effect of two different methods of high uterosacral ligament suspension through laparoscopic and trans-vaginal extrperitoneal wih preservation of uterus on young patients with middle pelvic organ prolapse.Methods The clinical data of 42 young and middle-aged patients with moderate to severe uterine prolapse who underwent HUS operation and systematic follow up was performed in Shunyi Maternity and Childcare Hospital of Beijing from January 2018 to January 2022 were retrospectively analyzed.According to the surgical method,they were divided into laparoscopic high uterosacral ligament suspension group(Laparoscopic group,n=22)and Trans-vaginal extrperitoneal high uterosacral ligament suspension group(Vaginal group,n=20),the uterus was preserved in both groups.The perioperative indicators were compared between the two groups,and the pelvic organ prolapse was evaluated before operation and 6 months after operation.The scores of Pelvic Floor Distress Inventory-short Form 20(PFDI-20)and Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire(PISQ-12)were recorded at 6 months after operation to evaluate the postoperative quality of life of patients,and the objective efficacy was evaluated by POP-Q score.Results There was no ureteral injury in the two groups.Compared with the Vaginal group,the Laparoscopic group had less intraoperative bleeding,shorter recovery of spontaneous urination,postoperative exhaust time and postoperative hospital stay(P<0.05).The levels of POP-Q indexes in the two groups were significantly higher than those before operation(P<0.05),and the C index of laparoscopic group was significantly higher than that of vaginal group(P<0.05).There was no significant difference in PFDI-20 score and PISQ-12 score between the two groups after operation(P>0.05).There was no recurrence in the two groups after 6 months of follow-up.Conclusion Both LHUS and VEHUS are safe and effective in the treatment of moderate to severe uterine prolapse in young patients.LHUS is more conducive

关 键 词：中盆腔脱垂 保留子宫 经腹腔镜高位骶韧带悬吊术 经阴道腹膜外高位骶韧带悬吊术 

分 类 号：R711[医药卫生—妇产科学]