经阴道网片盆底重建术的疗效中长期随访

Medium-and long-term efficacy of transvaginal mesh pelvic floor reconstruction

目的探讨盆腔脏器脱垂的经阴道网片盆底重建术是否保留子宫的疗效分析以及术后的中长期影响。方法选择2010年1月至2016年12月期间因盆腔脏器脱垂而手术治疗的患者76例为研究对象。根据手术方式匹配分为保留子宫组(UC)和切除子宫组(CH)两组,各38例。比较两组围手术期指标及盆腔器官脱垂定量分期法(POP-Q)术前、术后6个月、术后1年、术后5年分度评价客观疗效。采用盆底障碍量表简表(PFDI-20)、盆底障碍影响简易问卷(PFIQ-7)及盆腔器官脱垂/尿失禁性生活质量问卷(PISQ-12)评分判定主观疗效。结果UC与CH组比较,围手术期指标中住院天数(P<0.001)、术中出血(P<0.001)、手术时间(P<0.001)、术后排气时间(P=0.004)、留置尿管时间(P<0.001)均优于CH组。POP-Q分度:两组术后较术前均有所改善。PFDI-20、PFIQ-7、PISQ-12评分,UC、CH组各自不同时间(术前、术后6个月、术后1年、术后5年)比较,差异均有统计学意义(P<0.001),均有所改善;UC与CH组比较PISQ-12评分术后6个月(P<0.001)、术后1年(P<0.001)、术后5年(P<0.001)均优于CH组;中长期随访中,经阴道网片盆底重建术术后共3例盆腔感染、6例排尿困难,其余正常。结论经阴道网片盆底重建术中网片的使用安全有效,是否保留子宫不影响术后疗效,但保留子宫可改善围手术期指标、提高患者性生活质量。

Objective To analyze the medium-and long-term efficacy of transvaginal mesh pelvic floor reconstruction with or without uterus preservation.Methods A total of 76 patients with pelvic floor organ prolapse who underwent surgical treatment during Jan.2010 and Dec.2016 were selected as the research objects and divided into two groups:uterus conservation(UC)group and concomitant hysterectomy(CH)group,with 38 cases in either group.The perioperative indicators and changes of POP-Q scores before operation,6 months,1 year and 5 years after operation as the objective curative effect were compared.The Pelvic Floor Disorder Scale(PFDI-20),Pelvic Floor Disorder Impact Simple Questionnaire(PFIQ-7)and Pelvic Organ Prolapse/Urinary Incontinence Quality of Life Questionnaire(PISQ-12)scores as the subjective curative effect were compared.Results The UC group had shorter length of hospital stay(P<0.001),operation time(P<0.001),postoperative exhaust time(P=0.004),urinary catheter indwelling time(P<0.001)and less intraoperative bleeding volume(P<0.001)than the CH group.The POP-Q scores in both groups were improved after operation.There were significant differences in PFDI-20,PFIQ-7 and PISQ-12 scores at different times(P<0.001).The UC group had higher PISQ-12 score at 6 months(P<0.001),1 year(P<0.001)and 5 years(P<0.001)after the operation than the CH group.During the medium-and long-term follow-up,there were 3 cases of pelvic infection and 6 cases of dysuria,and no other complications were observed.Conclusion Transvaginal mesh pelvic floor reconstruction is safe and effective.Whether to preserve the uterus does not affect the postoperative efficacy,but preserving the uterus can improve perioperative indicators and quality of sexual life.