腹腔镜髂耻韧带固定术与腹腔镜阴道骶骨固定术治疗中盆腔脏器脱垂的疗效比较  

Laparoscopic pectopexy and laparoscopic sacrocolpopexy in the treatment of moderate pelvic organ prolapse:a comparison of the efficacy and safety

作　　者：田甜[1] 殷广洁[1] 蒙超 黄利英 高君琳 崔竹梅[1] TIAN Tian;YIN Guang-jie;MENG Chao;HUANG Li-ying;GAO Jun-lin;CUI Zhu-mei(Department of Gynecology,The Affiliated Hospital of Qingdao University,Qingdao 266061,China)

机构地区：[1]青岛大学附属医院妇科,青岛市266061

出　　处：《妇产与遗传(电子版)》2024年第2期9-14,共6页Obstetrics-Gynecology and Genetics (Electronic Edition)

摘　　要：目的 比较腹腔镜髂耻韧带固定术与腹腔镜阴道骶骨固定术治疗盆腔脏器脱垂的疗效和安全性。方法 回顾性分析2019年12月至2024年1月于青岛大学附属医院妇科因中盆腔脏器脱垂为主的中重度盆腔脏器脱垂(pelvic organ prolapse,POP)手术患者110例,根据手术方式分为腹腔镜髂耻韧带固定术+子宫及双附件切除术(LP组,n=55)和腹腔镜阴道骶骨固定术+子宫及双附件切除术者(LS组,n=55)。比较两组围手术期参数、手术并发症、POP-Q评分、盆底功能障碍问卷-20 (pelvic floor distress inventory-short form 20,PFDI-20)和盆底疾病生活质量影响问卷短表-7 (pelvicfloorimpactquestionnaireshortform,PFIQ-7)评分。结果 (1) LP组手术时间(171.6±52.3)min,明显短于LS组(192.5±57.8) min,差异有统计学意义(t=-1.99,P=0.049)。两组手术出血量、留置尿管时间、住院时间差异无统计学意义(P> 0.05)。(2) LP组平均随访(21.5±11.6)个月,LS组平均随访(25.9±13.5)个月。LP组新发压力性尿失禁1例,LS组术后排便功能障碍3例、新发压力性尿失禁3例、骶骨骨膜炎2例、网片暴露1例,两组手术并发症差异无统计学意义(P> 0.05)。(3)两组术后POP-Q指示点较术前明显上升(P <0.05),两组间术后POP-Q指示点比较无统计学意义(P> 0.05)。(4) LP组PFDI-20评分术后比术前显著下降[(20.21±13.81)vs.(109.98±15.10](Z=-9.066,P <0.05),PFIQ-7评分术后比术前显著下降[(6.23±6.21) vs.(135.76±36.94)],差异有统计学意义(Z=-9.196,P <0.05);LS组PFDI-20评分术后比术前显著下降[(21.25±16.88) vs.(108.35±6.65)],差异有统计学意义(Z=-9.069,P <0.05),PFIQ-7评分术后比术前显著下降[(7.36±6.07) vs.(142.86±40.50)],差异有统计学意义(Z=-9.160,P <0.05);两组术前和术后PFDI-20评分(Z=-0.657,P=0.511;Z=-0.069,P=0.945)和PFIQ-7评分差异比较(Z=-0.964,P=0.335;Z=-1.516,P=0.130)无统计学意义。结论 腹腔镜髂耻韧带固定术与阴道骶骨固定术治疗以中盆腔脱垂�Objective To compare the outcome of laparoscopic pectopexy and laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.Methods A retrospective analysis was performed on the clinical data of 110 patients with moderate to severe middle pelvic organ prolapse (POP) in the Department of Gynecology, Affiliated Hospital of Qingdao University from December 2019 to January 2024. Among them, 55 patients underwent laparoscopic pectopexy and hysterectomy (LP group), 55 patients underwent laparoscopic sacrocolpopexy and hysterectomy (LS group). Perioperative parameters, complications, POP‐Q score, PFDI‐20 and PFIQ‐7 questionnaires between the two groups were compared. Results ①Operative duration of LP group was shorter than that of LS group, and the difference was statistically significant [(171.6 ± 52.3)min vs (192.5 ± 57.8) min, t = -1.99,P = 0.049]. There were no significant differences in blood loss, catheter indwelling time, hospital stay time between the two groups (P > 0.05). ②The average follow‐up time was (21.5 ± 11.6) months in the LP group and (25.9 ± 13.5) months in the LS group. There were 3 cases of defecation dysfunction, 3 cases of de novo SUI, 2 cases of sacral periostitis and 1 case of mesh exposure in the LS group, while 1 case of de novo SUI in the LP group, without statistical significance between the two groups (P > 0.05). ③POP‐Q score in LP group and LS group were significantly increased after operation (P < 0.05). There was no statistical significance after the operation between the two groups (P > 0.05). ④Both PFDI‐20 and PFIQ‐7 score of LP group were significantly decreased after operation [(20.21 ± 13.81) vs. (109.98 ± 15.10)], Z = -9.066,P < 0.05;(6.23 ± 6.21) vs. (135.76 ± 36.94), Z = -9.196, P < 0.05]. Both PFDI‐20 and PFIQ‐7 score of LS group were significantly decreased after operation [(21.25 ± 16.88) vs. (108.35 ± 6.65), Z = -9.069, P < 0.05;(7.36 ± 6.07) vs. (142.86 ± 40.50), Z = -9.160, P < 0.05]. There were no significant differences betw

关 键 词：盆腔器官脱垂 阴道骶骨固定术 髂耻韧带固定术 

分 类 号：R711.23[医药卫生—妇产科学]