改良盆底重建与传统阴式手术治疗Ⅲ～Ⅳ度盆腔器官脱垂的远期疗效研究

Long-term Treatment Efficacy of Improved Pelvic Floor Rebuilding and Conventional Transvaginal Surgery in Ⅲ-Ⅳ Degree Pelvic Organ Prolapse

目的:比较改良盆底重建加子宫切除手术与传统阴式子宫切除加阴道前后壁修补术治疗Ⅲ～Ⅳ度盆腔器官脱垂(POP)的远期疗效,为临床治疗POP提供理论依据。方法:回顾性分析2010年1月至2013年1月我院收治按照POP定量分期法(POP-Q)Ⅲ～Ⅳ度的POP患者89例,按手术方式不同分为两组,改良盆底重建加子宫切除手术46例(重建组),传统阴式子宫切除加阴道前后壁修补手术43例(传统组),比较两组手术时间、术中出血量、术后残余尿量、尿管留置天数、住院天数等围手术期指标,以及术后随访情况。结果:两组患者手术时间、术中出血量、术后残余尿量、留置尿管时间及住院天数等比较差异无统计学意义(P>0.05)。术后1年、2年、5年两组患者的POP-Q分期Ba、BP、C、TVL各点值差异均有统计学意义(P<0.05)。两组术后生活质量评分(PFDI-20)均较术前明显降低,组间比较差异有统计学意义(P<0.05)。重建组主观治愈率100%,客观治愈率93.4%;传统组主观治愈率93%,客观治愈率86%。结论:改良盆底重建手术治疗Ⅲ～Ⅳ度POP的远期疗效优于经阴道传统手术,术后治愈率高,复发率低。

Objective:To compare the long-term treatment efficacy of improved pelvic floor rebuilding plus hysterectomy with that of conventional surgical transvaginal hysterectomy plus vaginal anterior and posterior wall repair for pelvic organ prolapse.To provide theoretical evidence for clinical treatment of pelvic organ prolapse.Methods :89 cases of Ⅲ-Ⅳ degree pelvic organ prolapse by POP-Q stage in our hospital from January 2010 to January 2013 were reviewed and analyzed.These cases were divided into two groups according to different surgical methods.46 cases of improved pelvic floor rebuilding plus hysterectomy were enrolled in the rebuilt group and 43 cases of conventional surgical transvaginal hysterectomy plus vaginal anterior and posterior wall repair were selected into the conventional group.The length of operation,amount of blood loss,amount of postoperative residual urine,duration of catheter indwelling,duration of hospitalization and other operational period indexes were compared.Results:There was not statistically significant difference in the length of operation,amount of bleeding,amount of postoperative residual urine,duration of catheter indwelling,duration of hospitalization and other operational period indexes between the two groups(P>0.05).Significant differences(P<0.05)were reported in the POP-Q stage Ba,BP,C and TVL point values in two groups after one,two,and five years of operations.The life quality evaluations(PFDI-20)of both groups obviously declined after operations.The inter-group difference was statistically significant(P<0.05).In rebuilt group,subjective cure rate was 100%,and objective cure rate was 93.4%.In conventional group,subjective cure rate was 93%,and objective cure rate was 86%.Conclusions:Improved pelvic floor rebuilding showed long-term advantage over conventional transvaginal surgery,with a higher cure rate and a lower relapse rate.