子宫韧带阴道残端悬吊术预防腹腔镜下非脱垂子宫全切除术后阴道脱垂的临床研究

Clinical research of vaginal stump suspension in preventing vaginal prolapse after laparoscopic total hysterectomy for non-prolapsed uterus

目的探讨子宫韧带阴道残端悬吊术预防腹腔镜下非脱垂子宫全切除术后阴道脱垂的作用。方法60例行腹腔镜下非脱垂子宫全切除术的患者,按照随机编号法分为悬吊组和参照组,每组30例。悬吊组患者术中给予子宫韧带阴道残端悬吊术,参照组患者术中不予特殊治疗。比较两组患者术后12个月的盆腔器官脱垂定量系统(POP-Q)指标,分析两组患者的手术情况。结果两组患者术前POP-Q系统测评均为非脱垂,术后12个月随访结果显示,悬吊组患者的C点、Ap点、Bp点测量值分别为(8.1±0.82)、(-2.95±0.34)、(-2.96±0.17)cm,均高于参照组的(6.8±0.53)、(-2.60±0.49)、(-2.82±0.25)cm,差异具有统计学意义(P<0.05)。两组患者的Aa点、Ba点测量值比较,差异无统计学意义(P>0.05)。两组患者均完成手术,且术后未出现出血、泌尿系统损伤等严重并发症。手术后30 d复查,患者阴道残端均愈合良好。结论腹腔镜下非脱垂子宫全切除术后实施子宫韧带阴道残端悬吊术,可避免患者阴道脱垂症状的发生,疗效较好,建议临床使用。

Objective To discuss the effect of vaginal stump suspension in preventing vaginal prolapse after laparoscopic total hysterectomy for non-prolapsed uterus.Methods A total of 60 patients who underwent total hysterectomy for non-prolapsed uterus were randomly divided into suspension group and reference group,with 30 cases in each group.Patients in the suspension group received vaginal stump suspension during the surgery,and patients in the reference group received no special treatment during the surgery.The 12-month postoperative pelvic organ prolapse quantification(POP-Q)indexes were compared between the two groups,and the surgical conditions of the two groups were analyzed.Results The preoperative POP-Q system measurements of both groups were non-prolapse,and the results of the 12-month postoperative follow-up showed that the C-point,Ap-point,and B-point measurements of patients in the suspension group were(8.1±0.82),(-2.95±0.34),and(-2.96±0.17)cm,which were higher than(6.8±0.53),(-2.60±0.49),and(-2.82±0.25)cm in the reference group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the Aa point and Ba point measurements between the two groups(P>0.05).Patients in both groups completed the surgery,and no serious complications such as bleeding and urinary system injury were observed after the surgery.On review 30 d after surgery,all patients had good healing of the vaginal stump.Conclusion The application of vaginal stump suspension after laparoscopic total hysterectomy for non-prolapsed uterus can avoid the symptoms of vaginal prolapse in patients with good efficacy,and is recommended for clinical use.