盆底重建术中3种中盆腔缺陷手术临床效果评价

Comparison of three operations on middle pelvic defect-dominated pelvic organ prolapse

目的比较经阴道骶棘韧带固定术(vaginal sacrospinous ligament fixation,SSLF)、腹腔镜阴道骶骨固定术(laparoscopic sacrocolpopexy,LSC)及CY Liu系列腹腔镜下自体组织盆底修复术(laparoscopic CY Liu pelvic floor repair surgery with autologous tissue,CY Liu)在治疗中重度中盆腔器官脱垂的临床疗效。方法回顾性分析贵阳市妇幼保健院2017年3月—2021年12月收治的中盆腔器官脱垂Ⅲ度及以上且有手术意愿的患者79例,分为3组:经阴道骶棘韧带固定术(SSLF)30例、腹腔镜阴道骶骨固定术(LSC)23例(双侧组)及腹腔镜下自体组织盆底修复术(CY Liu)26例。比较3组患者术中、术后各项指标及疗效情况。结果SSLF组与LSC组、CY Liu组相比手术时间更短,差异有统计学意义(P<0.05),而LSC组与CY Liu组相比手术时间差异无统计学意义(P>0.05);3组术中失血量及术后住院天数比较,差异均无统计学意义(P>0.05)。3组术前盆腔器官脱垂定量分度法(pelvic organ prolapse quantitation,POP-Q)评分比较,差异无统计学意义;各组内术前与术后两时间点的POP评分、盆底功能障碍问卷-简要版20(pelvic floor distress inventory-short form20,PFDI-20)评分比较,差异均有统计学意义(P<0.05)。SSLF组与LSC组术后C点比较,差异有统计学意义(P<0.05),SSLF组与CY Liu组术后C点比较,差异有统计学意义(P<0.05);CY Liu组与LSC组术后C点比较,差异无统计学意义(P>0.05)。结论SSLF操作简单,手术时间短,近期疗效确切;LSC疗效持久,能更好的改善患者生活质量,但存在网片暴露、侵蚀等风险;CY Liu短期疗效良好,在治疗女性中盆腔缺陷器官脱垂上是安全有效的。

Objective To compare the clinical curative effects of the vaginal sacrospinous ligament fixation(SSLF),the laparoscopic sacrocolpopexy(LSC)and laparoscopic CY Liu pelvic floor repair surgery with autologous tissue(CY Liu)in the treatment of moderate and severe pelvic organ prolapse.Methods A total of 79 patients with middle pelvic prolapse(gradeⅢor above)who were willing to receive operation were selected and divided into three groups in the Department of Gynecological Oncology,Guiyang Health Center for Women and Children from March 2017 to December 2021.They were divided into transvaginal SSLF group,LSC group and CY Liu group.The indexes and the curative effects in three groups during and after the operation were compared.Results The operation time was the least in the SSLF group(P<0.05),but there was no significant difference in the operation time between LSC group and CY Liu group(P>0.05).There were no significant differences in the intraoperation bleeding and postoperative hospitalization(P>0.05).There were significant differences in POP score and PFDI-20 score between before and after operation in the three groups(P<0.05).The C points of the LSC group and CY Liu group were lower than that of the SSLF group.Conclusion There are advantages of simple surgical procedure,less operation time and accurate effect in SSLF.LSC has good effect of patients and improves the postoperative life quality,but there is the possibility of mesh exposure.Laparoscopic CY Liu pelvic floor repair surgery with autologous tissue may be safe and effective in the treatment of female middle pelvic organ prolapse.