盆底重建手术中保留子宫效果的临床研究

Clinical study of uterine-reserved in the pelvic floor reconstruction

目的 评价保留子宫在盆底重建手术中的效果,为最佳术式的选择提供依据.方法 阴道前后壁膨出合并子宫脱垂、压力性尿失禁患者31例,其中行经阴道全盆腔悬吊术（添加网片）14例（研究组）,行阴式子宫全切＋阴道前后壁修补术17例（对照组）,比较两组患者术中情况、术后恢复及生活质量的变化.结果 研究组手术时间、术中出血量、术后排气时间、抗生素应用时间、住院时间均低于对照组（P＜0.05）.研究组术后排尿异常、腹胀感[14%（2/14）、14%（2/14）]明显少于对照组[53%（9/17）、24%（4/17）]（P＜0.05）,性生活满意率[71%（10/14）]明显高于对照组[47%（8/17）]（P＜0.05）.两组患者术前、术后盆腔检查各指示点值比较差异均无统计学意义（P＞0.05）;但两组术后各指示点值均明显低于术前（P＜0.05）.结论 盆底重建手术中保留子宫对维持盆底结构稳定具有一定的意义,有手术时间短、出血量少、恢复快等优点,近期效果与切除子宫患者相似,有利于降低高龄妇女围手术期的风险.

Objective To evaluate the effect of uterine-reserved in the pelvio floor reconstruction,and select the best surgery for patients. Methods Through the observation and follow-up for 14 cases of uterine-reserved （experimental group） and 17 cases of uterine-removed （control group）, to compare the information during the surgery, postoperative recovery, and quality of life of the two groups. Results The operation time, blood loss, postoperative discharge time, antibiotics application time and hospitalization time in experimental group were significantly lower than those in control group（P 〈 0.05）. The paruria, abdominal distention in experimental group [14%（2/14）, 14%（2/14）] were significantly lower than those in control group [53% （9/17）, 24% （4/17）] （P 〈 0.05）, and sexual satisfaction was significantly higher in experimental group than that in control group [71% （10/14） vs. 47% （8/17）] （P 〈 0.05）. There were no significant difference in pelvic pain, constipation of the two groups （P〉 0.05）. The POP-Q scores were normal after the operation both the two groups, each group beforeand after surgery compared the POP-Q score, were statistically significant （P 〈 0.05）. Conclusions Uterine-r eserved in the pelvic floor reconstruction can maintain the structural stability of the pelvic floor, and has the advantage of shorter operation time, less bleeding, more rapid recovery. Recent results are similar with hysterectomy, can reduce the risk of perioperative period to the elderly women.