改良全盆底网片悬吊手术在治疗老年女性盆腔脏器脱垂患者中的应用

Application of modified total pelvic reconstruction in the treatment of pelvic organ prolapse in elderly women

目的评估改良全盆底网片悬吊手术在治疗老年女性盆腔脏器脱垂中的应用，了解改良全盆底手术的有效性、安全性。方法选择2008年3月至2010年4月因盆腔脏器脱垂要求手术的入院患者105例，其中观察组68例，接受改良全盆底网片悬吊手术；对照组37例，接受全盒底重建术（Prolift）手术。记录2组患者手术期的出血量、手术时间、残余尿、手术并发症、医疗费用、出院时间等；观察并记录术后6个月患者手术治疗效果，对2组患者随访结果进行对比分析。结果手术期临床治疗效果，观察组患者的术中出血量、住院费用较对照组低（P〈0．05），而手术时间、术后残余尿量、术后下床活动时间、肛门排气时间、术后最高体温、术后平均住院天数2组间差异无统计学意义（P〉O．05）。术中观察到阴道壁穿孔7例，其中观察组4例，对照组3例，未观察到术中膀胱、直肠等脏器穿孔；观察组68例患者中，盆腔器官脱垂定量分期法（POP—Q）检查评分为治愈的64例（94．1％），无效4例（5．9％）；对照组37例患者中，治愈36例（97．3％），无效1例（2．7％），非劣性检验结果显示观察组手术疗效非劣效于对照组（u=2．252，P=0．012）。结论改良全盆底网片悬吊手术和Prolift手术，是一种临床治疗效果确切的、安全的微创手术，但改良全盆底网片悬吊手术费用相对低廉，更易被患者接受，具有很大的临床应用前景。

Objective To evaluate the efficacy and safety of modified total pelvic reconstruction for pelvic organ prolapse in elderly women. Methods 105 patients required operation for treatment of pelvic organ prolapse were enrolled in this study. Patients were divided into experimental group （n =68, treated with the modified total pelvic reconstruction） and control group （n=37, receiving prolift procedure）. Objective indexes including bleeding volume, operative time, residual urine volume, postoperative complications, medical expenses, hospitalization time were recorded. Clinical efficacy and follow up results were recorded and compared between the two groups at 6 months after operation. Results Bleeding volume and hospitalization costs were lower in experimental group than in control group （both P〈0.05）, while the operative time, residual urine volume, time out of bed, anal exhaust time, the maximum body temperature, mean postoperative hospital stay showed no significant differences between the two groups （all P〉0.05）. Vaginal perforation was observed in 7 cases, with 4 cases in experimental group and 3 cases in control group. No serious complications such as bladder and rectum perforation were observed. According to pelvic organ prolapse quantitation （POP-Q） score, 64 cases （94.1%） were cured and 4 cases （5.9%） were invalid in experimental group, while 36 cases （97.3%） were cured and 1 case （2.7%） was invalid in control group. The non- inferiority test showed that clinical efficacy in experiruental group was non-inferior to that in control group （u 2. 252, P〈0.05）. Conclusions Modified total pelvic reconstruction is an effective and safe minimally invasive surgery, which is similar to prolift surgical operation, but it is relatively inexpensive, which is easier to be accepted by Chinese patients, with a great perspective in clinical application.