盆底重建术治疗重度盆腔脏器脱垂疗效评价

The effect evaluation of the modified pelvic reconstructive surgery for severe pelvic organ prolapse

目的评价盆底重建术治疗重度盆腔脏器脱垂的手术疗效。方法2006年11月至2008年10月在江西省妇幼保健院收治207例POP-Q分期子宫脱垂Ⅲ～Ⅳ度伴不同程度阴道壁脱垂的患者,随机分为盆底重建术组(重建组)105例,阴式子宫切除及阴道前后壁修补术组(阴宫组)102例,比较两组术中出血量、手术时间、术后住院日等围手术期指标,术后复诊以POP-Q分度和P-QOL量表作为客观及主观疗效评价指标。结果重建组术中出血量、手术时间及术后住院日分别为(90.56±46.41)mL、(75.28±21.87)min、(4.6±1.73)d;阴宫组分别为(98.84±36.89)mL、(75.55±20.22)min、(5.33±1.35)d,重建组术中出血量及手术时间低于阴宫组(P>0.05),重建组术后住院日少于阴宫组(P<0.05)。术后3个月、6个月、1年治愈率重建组分别为94.12%、95.65%、92.86%;阴宫组为93.88%、88.89%、77.61%,术后3个月及6个月两组比较,差异无统计学意义(P>0.05),1年后两组比较,差异有统计学意义(P<0.05)。结论盆底重建术治疗重度盆腔脏器脱垂,能够恢复和增强盆底支持结构及功能,可保留子宫;术后近期疗效肯定,生活质量明显改善,中远期疗效需继续随访。

Objective To evaluate the efficacy of the modified pelvic reconstructive surgery for severe pelvic organ prolapse. Methods Between Nov. 2006 and Oct. 2008, 207 patients of pelvic organ prolapse quantitative for the uterine prolapse Ⅲ-Ⅳ degrees with different levels of vaginal prolapse in the Maternity and Child Healthcare Hospital of Jangxi Province were randomly divided into two groups, 105 patients were treated with modified pelvic reconstructive surgery （the PRS group）, 102 patients underwent total vaginal hysterectomy and colporrhaphy （the vaginal hysterectomy group）, intra-operative blood loss, operating time and post-operative hospital stay were compared, patients were assessed objectively （according to pelvic organ prolapse quantitative examination score） and subjectively （pelvic organ prolapse quality of life score）. Results Mean intra-operative blood loss, mean operating time and mean post-operative hospital stay was （90.56±46.41）mL, （75.28±21.87）min, （4.6±1.73）d in the PRS group, and （98.84±36.89） mL, （75.55±20.22） min, （5.33±1.35）d in the vaginal hysterectomy group respectively, Mean intra-operative blood loss and mean operating time are less in the PRS group than in the vaginal hysterectomy group, but no significant difference existed （ P 〉 0.05）, mean postoperative hospital stay is significantly less in the PRS group （ P 〈 0.05 ） ; the cure rates in the PRS group were respectively 94.12%, 95.65% and 92.86% followed up at 3 months, 6 months and 1 year after the operation, the vaginal hysterectomy group was 93.88%, 88.89%, 77.61% ,no significant difference existed at 3 months and 6 months after the operation （ P 〉 0.05 ）, significant difference existed 1 year after the operation （ P 〈 0.05 ）. Con- clusion Modified pelvic reconstructive surgery for treatment of severe pelvic organ prolapse can restore and strengthen the structure and function of pelvic floor support as well as uterine preservation; the surgery present good effect on improving the short term quality of life, the long-term effect need further follow-up.