传统阴式手术治疗盆腔脏器脱垂术后疗效研究

Outcomes of Pelvic Organ Prolapse Treated by Traditional Surgical Procedures

目的 评价我院传统阴式手术治疗盆腔脏器脱垂的效果,探讨导致手术后复发的危险因素. 方法 对我院2000年1月～2005年12月因中重度盆腔脏器脱垂行首次传统手术治疗(经阴道全子宫切除、阴道前后壁修补以及会阴修补)的73例进行回顾分析以及随访.问卷调查主观症状治愈、手术前后尿失禁情况,依据POP-Q(Pelvic Organ Prolapse Quantification)评分判定客观治愈情况.比较复发组与客观治愈组之间的差异. 结果 73例随访8～62个月,平均28.6月.主观治愈率94.5%(69/73),客观治愈率61.6%(45/73).单纯前壁膨出复发24.7%(18/73),单纯后壁膨出复发8.2%(6/73),同时存在阴道前壁以及后壁的膨出复发5.5%(4/73).无阴道穹隆脱垂或子宫脱垂.因复发二次手术2.7%(2/73).复发组与未复发组在手术时年龄、手术时是否绝经、手术前脱垂程度、是否伴慢性咳嗽等方面差异均无显著性(P＞0.05).手术后35例原有尿失禁患者中有17.1%(6/35)症状消失,5.7%(2/35)尿失禁加重.术前无尿失禁患者23.7%(9/38)手术后出现尿失禁.73例中共有11例手术后尿失禁加重. 结论 传统手术方式治疗中重度盆腔脏器脱垂,客观治愈率低,阴道前壁膨出复发率高.对前盆腔的修补以及对潜在的尿失禁的治疗应该引起足够重视.

Objective To evaluate the therapeutic effect of traditional surgical procedures on pelvic organ prolapse,and to investigate the risk factors of postoperative recurrence.Methods From January 2000 to December 2005,a total of 73 patients with moderate-to-severe pelvic organ prolapse received traditional surgical treatment(including total vaginal hysterectomy,anterior colporrhaphy,and posterior colporrhaphy) in our hospital.The data of the patients were retrospectively analyzed.The subjective cure rate and pre-and postoperative incontinence status were surveyed by questionnaire.The subjective cure rate was determined by the Pelvic Organ Prolapse Quantification(POP-Q).Then,the difference between the recurrent patient and those who cured objectively were compared. Results The 73 patients were followed up for 8-62 months(mean,28.6 months).The subjective and objective cure rates were 94.5%(69/73) and 61.6%(45/73) respectively.The rates of recurrences of cystocele,rectocele,or both of them were 24.7%(18/73),8.2%(6/73),and 5.5%(4/73).No vault or uterine prolapse recurred after the operation.Two patients(2.7%) received re-operation because of recurrence.No significant difference was detected in the age,menopausal status,preoperative severity of prolapse,and chronic cough between the recurrent and non-recurrent patients(P>0.05).In the 35 patient who had unitary incontinence before the operation,the symptom disappeared in 6(17.1%) patients,and deteriorated in 2(5.7%).While in the 38 patients without urinary incontinence before the operation,9(23.7%) showed the symptom postoperation.Totally,urinary incontinence was developed in 11 patients after the operation.Conclusions The patients with moderate-to-severe pelvic organ prolapse treated by traditional surgical procedures have a low rate of objective cure and a high rate of recurrent cystocele.It is important to repair the anterior pelvic floor during the operation.And the surgeons should be alert to the possibility of urinary incontinence.