腹腔镜下高位宫骶韧带悬吊术与经阴道骶棘韧带固定术对重度盆腔器官脱垂患者盆底功能、尿动力学影响的比较  

Observation of the effects of laparoscopic high sacral ligament suspension and transvaginal sacral ligament fixation on pelvic floor function and urodynamics in patients with severe pelvic organ prolapse

作　　者：何雪妍 李红英[2] 王婷慧 程慧[1] He Xueyan;Li Hongying;Wang Tinghui;Cheng Hui(Medical College,Wuhan University of Science and Technology,Hubei Province,Wuhan 430065,China;不详)

机构地区：[1]武汉科技大学医学部医学院,430065 [2]湖北省妇幼保健院妇科,武汉430070

出　　处：《疑难病杂志》2024年第4期462-466,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：湖北省卫生健康委员会联合基金项目(WJ2019H188)。

摘　　要：目的观察腹腔镜下高位宫骶韧带悬吊术、经阴道骶棘韧带固定术对重度盆腔器官脱垂患者临床相关指标的影响。方法收集2021年5月—2022年5月湖北省妇幼保健院妇科诊治重度盆腔器官脱垂患者73例的病例资料进行回顾性分析,根据治疗方法不同分为观察组37例及对照组36例。观察组开展腹腔镜下高位宫骶韧带悬吊术,对照组开展经阴道骶棘韧带固定术。比较2组围术期指标及预后情况,不同阶段器官脱垂情况、生活质量、尿动力学变化。结果观察组手术时间长于对照组,术中出血量少于对照组,拔除尿管时间、术后住院时间短于对照组(t/P=21.641/<0.001、6.195/<0.001、15.199/<0.001、17.575/<0.001)。观察组术后6个月PFIQ-7评分、PFDI-20评分低于对照组,各项POP-Q指示点(Aa、Ba、C、Bp)、I-QOL评分、最大膀胱容量、最大尿流率、平均尿流率高于对照组(t/P=5.189/<0.001、22.447/<0.001、11.051/<0.001、16.916/<0.001、31.005/<0.001、3.477/<0.001、11.211/<0.001、3.503/<0.001、5.728/<0.001、10.010/<0.001);观察组患者术后6个月新发压力性尿失禁率、再次手术率以及并发症发生率低于对照组[χ^(2)(t)/P=5.471/0.019、4.103/0.042、4.364/0.036]。结论腹腔镜下高位宫骶韧带悬吊术、经阴道骶棘韧带固定术均能作为重度盆腔脱垂患者有效的治疗方案,前者术式较后者手术用时略长,但在改善患者术后盆底功能以及尿动力学方面效果更优。Objective To analyze the feasibility of laparoscopic high position hysterosacral ligament suspension and transvaginal sacrospinal ligament fixation as treatment options for patients with severe pelvic organ prolapse,and to observe the impact of the above two surgical methods on clinical related indicators of patients.Methods From May 2021 to May 2022,73 patients with severe pelvic organ prolapse were treated in the Gynecology Department of Hubei Maternal and Child Health Hospital,there clinical data were collected and analyzed retrospectively.They were divided into an observation group of 37 cases and a control group of 36 cases according to different treatment methods.The observation group underwent laparoscopic high sacral ligament suspension surgery,while the control group underwent transvaginal sacral spine ligament fixation surgery.Compare perioperative indicators and prognosis between two groups,as well as organ prolapse,quality of life,and changes in urodynamics at different stages.Results The observation group had longer surgical time than the control group,less intraoperative bleeding,shorter removal time of the urinary catheter,and shorter postoperative hospital stay than the control group(t/P=21.641/<0.001,6.195/<0.001,15.199/<0.001,17.575/0.001).The observation group showed lower values in PFIQ-7 scores,and PFDI-20 scores at 6 months after surgery compared to the control group,including various POP-Q indicator points,I-QOL scores,maximum bladder volume,and maximum urinary flow rate The average urine flow rate showed higher values compared to the control group(t/P=5.189/<0.001,22.447/<0.001,11.051/<0.001,16.916/<0.001,31.005/<0.001,3.477/<0.001,11.211/<0.001,3.503/<0.001,5.728/<0.001,10.010/<0.001);The incidence of newly diagnosed stress urinary incontinence,reoperation rate,and incidence of complications in the observation group were lower than those in the control group at 6 months after surgery[χ^(2)(t)/P=5.471/0.019,4.103/0.042,4.364/0.036].Conclusion Laparoscopic high sacral ligament suspension s

关 键 词：重度盆腔器官脱垂 腹腔镜下高位宫骶韧带悬吊术 经阴道骶棘韧带固定术 盆底功能 生活质量 

分 类 号：R713.1[医药卫生—妇产科学]