不同手术方式治疗重度盆腔器官脱垂的疗效及复发因素分析

Analysis on the curative effects of different surgical methods on severe pelvic organ prolapse and the influencing factors of recurrence

目的:探索三种不同的手术方法对重度盆腔器官脱垂(POP)的临床疗效。方法:选择POP手术患者60例,随机分为甲、乙两组,各30例;甲组行全盆底重建术,乙组行阴式子宫全切+骶棘韧带固定术,比较两组患者的临床效果和复发因素。结果:两组患者的手术时间、出血量、术中并发症、住院时间、术后并发症、术后病率均无统计学差异(P>0.05);甲组患者性生活满意度、生活质量均显著高于乙组(P<0.05),术后6、12个月时,甲组复发率显著低于乙组(P<0.05);疾病严重程度、前壁脱垂、传统手术方式、手术开展<6月均为POP复发的高危因素(OR=3.87,P<0.05)。结论:全盆底重建术疗效较好,复发率低,术后生命质量较高,值得临床推广。

Objective： To explore the clinical curative effects of three different surgical methods on pelvic organ prolapse （POP） . Methods： Sixty POP patients were selected and randomly divided into group A and group B, thirty patients in each group; the patients in group A were treated with total pelvic floor reconstruction, while the patients in group B were treated with transvaginal total hysterectomy plus sacral spine ligament fixation; the clinical effects and influencing factors of recurrence in the two groups were compared. Results： There was no statistically significant difference in operation time, the amount of bleeding, intraoperative complications, hospitalization time, postopera- tive complications, and postoperative morbidity between the two groups （ P 〉 0. 05 ） ; the satisfaction of sexual life and quality of life in group A were statistically significantly higher than those in group B （ P 〈 0. 05 ） ; the recurrence rates at six and twelve months after operation in group A were statistically significantly lower than those in group B （ P 〈 0. 05 ） ; the high risk factors of recurrence of POP included severity degree of the disease, front wall prolapse, traditional surgical method, carrying out surgery less than six months （ OR = 3.87, P 〈 0. 05） . Conclusion： The curative effect of total pelvic floor reconstruction is relatively good, the recurrence rate is low, and the quality of life after operation is relatively high, which is worthy to be popularized in clinic.