经阴道EHUS术治疗中盆腔缺陷的临床研究  

Clinical Study on the Treatment of Pelvic Defectsin Transvaginal EHUS Surgery

作　　者：牛竹林 张咏梅[2] 王燕萍 李荣玲 温悦 NIU Zhulin;ZHANG Yongmei;WANG Yanping;LI Rongling;WEN Yue(Ningxia Medical University,Yinchuan 750004,China;The First People’s Hospital of Yinchuan,the Second Clinical Medical College of Ningxia Medical University,Yinchuan 750001,China)

机构地区：[1]宁夏医科大学,银川750004 [2]银川市第一人民医院,宁夏医科大学第二临床医学院,银川750001

出　　处：《宁夏医科大学学报》2024年第6期598-603,共6页Journal of Ningxia Medical University

基　　金：宁夏卫生健康委科研项目(2022-NWKY-083)。

摘　　要：目的评估阴式腹膜外高位宫骶韧带悬吊术(EHUS)治疗中盆腔缺陷的临床疗效。方法回顾性分析2020年7月1日至2022年7月31日在银川市第一人民医院因中盆腔器官脱垂≥Ⅱ度行手术治疗的患者资料,符合入组条件且随访资料齐全的患者共85例,其中绝经前患者27例,21例行EHUS术定义为EHUS组1,6例行前盆重建术定义为前盆组1;绝经后患者58例,24例行EHUS术定义为EHUS组2,34例行前盆重建术定义为前盆组2。比较各组一般资料、围术期相关指标、盆腔器官脱垂定量系统(POP-Q)各指示点(Aa、Ba、C、Ap、Bp)、盆底功能障碍问卷简表(PFDI-20)、性功能问卷(PISQ-12)及术后并发症。结果EHUS组2与前盆组2患者手术时间及术后住院时间比较,差异均无统计学意义(P均>0.05);术后留置尿管时间及术中出血量EHUS组2均高于前盆组2(P均<0.05)。EHUS组1、EHUS组2、前盆组1和前盆组2患者术后1年POP-Q各点均较术前减小(P均<0.05);各组PFDI-20评分较术前降低(P均<0.05),而PISQ-12评分较术前升高(P均<0.05)。EHUS组1与EHUS组2患者术后1年POP-Q分度中各指示点、PFDI-20评分、PISQ-12评分比较差异均无统计学意义(P均>0.05)。EHUS组2与前盆组2患者术后1年POP-Q分度中各指示点、PISQ-12评分比较差异均无统计学意义(P均>0.05);在生活质量PFDI-20评分中,EHUS组2的评分较前盆组2低(P<0.05)。EHUS组1及EHUS组2患者未出现输尿管梗阻、脱垂复发、性生活不适等并发症。前盆组2发现网片暴露1例,该患者同时合并阴道壁溃疡及新发性交痛,并发症发生率为2.5%。结论EHUS在治疗中盆腔缺陷方面疗效可以达到使用网片的前盆腔重建术的效果,可有效治疗中盆腔器官脱垂。Objective To evaluate the clinical efficacy of vaginal extraperitoneal high uterosacral suspension surgery(EHUS)for the treatment of middle pelvic cavity defect.Methods A retrospective case-control study was conducted to collect 85 patients with pelvic organ prolapse≥Ⅱdegrees who underwent surgical treatment at the First People’s Hospital of Yinchuan City from July 1,2020 to July 31,2022.Through retrospective research analysis,among them,there were 27 premenopausal patients,21 cases of EHUS surgery were defined as EHUS group 1,and 6 cases of anterior pelvic reconstruction surgery and were defined as anterior pelvic group 1.There were 58 postmenopausal patients,of which 24 underwent EHUS surgery were defined as EHUS group 2,and 34 underwent anterior pelvic reconstruction surgery were defined as anterior pelvic group 2.The general information,perioperative related indicators,POP-Q indicators(Aa,Ba,C,Ap,Bp),pelvic floor dysfunction disease related questionnaire(PFDI-20),pelvic floor organ prolapse on sexual function questionnaire(PISQ-12),and postoperative complications among each group were compared.Results There was no statistically significant difference in surgical time and postoperative hospital stay between EHUS group 2 and anterior pelvic group 2 patients(P all>0.05).The postoperative indwelling catheter time and intraoperative blood loss in EHUS group 2 were higher than in anterior pelvic group 2(P all<0.05).EHUS Group 1,EHUS Group 2,Anterior Pelvic Group 1,and Anterior Pelvic Group 2 all showed a decrease in POP-Q at 1 year post surgery compared to preoperative levels(P all<0.05);The PFDI-20 score in each group decreased compared to preoperative levels(P all<0.05),while the PISQ-12 score increased compared to preoperative levels(P all<0.05).There were no statistically significant differences in the POP-Q scores,PFDI-20 scores,and PISQ-12 scores between EHUS group 1 and EHUS group 2 at 1 year after surgery(P all>0.05).There were no statistically significant differences in the POP-Q scores and PISQ-12 s

关 键 词：盆腔器官脱垂 中盆腔脱垂 阴式腹膜外高位宫骶韧带悬吊术 前盆腔重建术 临床疗效 

分 类 号：R711.23[医药卫生—妇产科学]