机器人辅助阴道骶骨固定术治疗重度盆腔器官脱垂的疗效分析(附手术视频)  

Clinical analysis of robot-assisted sacrocolpopexy for severe pelvic organ prolapse(with surgical video)

作　　者：王丽杉 左丽 夏玉芳[1] 孙欣[1] 娄艳辉[1] WANG Lishan;ZUO Li;XIA Yufang;SUN Xin;LOU Yanhui(Department of Gynecology,the Affiliated Hospital of Qingdao University,Qingdao 266100,China;Department of Gynaecology and Obstetrics,Zhoucun Maternal and Child Health Hospital,Zibo 255300,China)

机构地区：[1]青岛大学附属医院妇科,山东青岛266100 [2]淄博市周村区妇幼保健院妇产科,山东淄博255300

出　　处：《机器人外科学杂志（中英文）》2024年第3期420-425,共6页Chinese Journal of Robotic Surgery

基　　金：青岛市市南区科技计划项目(2022-2-006-YY)。

摘　　要：目的:探讨机器人辅助阴道骶骨固定术治疗重度盆腔器官脱垂的效果及安全性。方法:纳入2021年1月—2023年12月在青岛大学附属医院妇科接受机器人辅助阴道骶骨固定术(RASC)治疗的54例重度盆腔器官脱垂患者为研究对象。32例(59.26%)患者因合并阴道后壁重度脱垂接受改良的机器人辅助下肛提肌筋膜-阴道骶骨固定术,22例(40.74%)患者行常规阴道骶骨固定术,其中有5例患者因合并SUI同时行TVT-O术。记录所有患者的围术期相关资料,收集患者术后1个月、6个月及12个月的随访数据。对比了患者术前、术后盆腔脏器脱垂的治疗效果、安全性及可行性。采用盆底功能障碍问卷(PFDI-20)和盆底障碍影响简易问卷(PFIQ-7)评估患者术后主观满意度,并采用PISQ-12问卷评价其性生活满意度。结果:所有手术均顺利完成,无中转开腹,未见大血管及邻近器官损伤。平均手术时间(186.11±68.91)min,术中平均出血量(40.37±19.62)ml,平均术后住院时间(3.63±1.70)d。所有患者均完成术后12个月随访,最长随访时间22个月。患者术后6个月、12个月POP-Q评分均较术前有明显的改善,无复发,术后客观及主观治愈率均为100%。PFDI-20及PFIQ-7调查结果显示,患者术后6个月及12个月生活质量均得到显著改善(P<0.001);术后12个月有40例患者恢复性生活,所有患者均未述性生活疼痛及不适,PISQ-12评分在手术前后无显著差异。术后阴道残端感染2例(3.7%),持续阴道残端网片暴露1例(1.85%),于术后1年再次缝合后愈合。结论:达芬奇机器人手术系统治疗重度盆腔器官脱垂,尤其是合并重度阴道后壁脱垂及肠疝疗效确切、出血量少、手术时间短,可作为该类疾病的有效治疗方案之一。Objective:To explore the efficacy and safety of robot-assisted sacrocolpopexy in the treatment of severe pelvic organ prolapse.Methods:A total of 54 patients with severe pelvic organ prolapse who received robot-assisted sacrocolpopexy(RASC)in the Department of Gynecology,Affiliated Hospital of Qingdao University from January 2021 to December 2023 were included in the study.Among them,32 patients(59.26%)underwent modified robotic levator ani muscle fascia-sacrocolpopexy for severe posterior vaginal prolapse,22 patients(40.74%)underwent conventional sacrocolpopexy,and 5 patients underwent TVT-O for SUI.The perioperative and operative data of all patients were recorded,and the follow-up data at 1 month,6 months and 12 months after surgery were collected to compare the treatment effect,safety and feasibility of POP.The pelvic floor Dysfunction Questionnaire(PFDI-20)and the Simple Pelvic Floor Dysfunction Impact Questionnaire(PFIQ-7)were used to evaluate the subjective satisfaction after surgery,and the PISQ-12 was used to evaluate the sexual satisfaction.Results:All surgeries were successfully completed,no conversion to laparotomy,no damage to large blood vessels and adjacent organs.The mean intraoperative blood loss was(40.37±19.62)ml,the mean operative time was(186.11±68.91)min,and the mean postoperative hospital stay was(3.63±1.70)d.All 54 patients were followed up at 6 months and 12 months after surgery,and the longest follow-up was 22 months.POP-Q scores after surgery were significantly improved compared with those before surgery,and no patients recurred.The objective and subjective cure rates were 100%.PFDI-20 and PFIQ-7 showed that the quality of life of patients was significantly improved at 6 and 12 months after operation.In 12 months after surgery,40 patients resumed sexual activity,all patients did not report sexual pain and discomfort except one patient with mesh exposure,and there was no significant difference in PISQ-12 scores before and after surgery.Postoperative vaginal stump infection occurred in

关 键 词：机器人辅助手术 盆腔器官脱垂 肠疝 阴道骶骨固定术 

分 类 号：R608[医药卫生—外科学] R713[医药卫生—临床医学]