老年重度盆腔器官脱垂患者阴道完全封闭术与阴道部分封闭术围手术期情况比较

Comparison of periOperative conditions between total and partial colpocleisis for elderly patients suffered from severe pelvic organ prolapse

目的探讨阴道完全封闭术与阴道部分封闭术治疗老年重度盆腔器官脱垂(POP)患者的围手术期情况。方法选取2014年1月至2017年10月采取阴道完全封闭术或阴道部分封闭术治疗的老年重度POP患者286例,年龄(76.0±5.1)岁(范围:60~90岁),其中220例(76.9%,220/286)伴有1种以上的内科合并症。分析阴道完全封闭术和阴道部分封闭术患者的围手术期指标,包括:手术时间、术中出血量、术后住院时间、围手术期并发症、术前排尿困难症状的术后改善情况。结果286例患者中,行阴道完全封闭术172例(60.1%),阴道部分封闭术114例(39.9%);有48例(16.8%,48/286)合并压力性尿失禁的患者同时行抗尿失禁手术;术前存在排尿困难的患者129例(45.1%,129/286)。286例患者的手术时间为(67±22)min,术中出血量为(52±57)ml,术后住院时间为(5.9±1.9)d(范围:2~16 d)。286例患者发生围手术期并发症25例(8.7%,25/286),包括术中膀胱损伤1例、术后盆腔血肿3例、肠梗阻1例、心房颤动5例、术后病率3.5%(10/286)、肺栓塞3例、下肢静脉血栓1例、尿潴留经保留尿管无效后电刺激治疗1例。阴道完全封闭术与阴道部分封闭术患者的手术时间分别为(67±22)和(68±20)min,术中出血量分别为(58±62)和(41±45)ml,住院时间分别为(5.9±1.9)和(6.0±1.8)d,围手术期并发症发生率分别为8.1%(14/172)和9.6%(11/114),术前存在排尿困难的患者术后自主排尿后测残余尿量分别为(35±43)和(34±41)ml;以上指标分别比较,差异均无统计学意义(P均>0.05)。结论阴道封闭术对于治疗高龄体弱、无性生活要求、不能耐受盆底重建手术的老年患者,是安全、出血少、恢复快的术式。阴道完全封闭术与阴道部分封闭术的围手术期情况无显著区别,术式的选择要根据有无子宫恶性肿瘤可能、患者年龄、意愿和全身状况等因素综合决定。

ObjectiveTo study perioperative period conditions of total and partial colpocleisis with severe pelvic organ prolapse (POP) in elderly patients.MethodsFrom Jan. 2014 to Oct. 2017 286 severe POP elderly patients underwent total or partial colpocleisis. The mean age was (76.0±5.1) years (60-90 years) . Of which, 220 patients (76.9%, 220/286) presented more than one kind of medical disease. The operative time, intraoperative blood loss, hospital stay after surgery, postoperative complications, preoperative urinary dysuria symptoms of total and partial colpocleisis in treatment of 286 patients were analyzed.ResultsIn 286 patients, 172 patients (60.1%) underwent total colpocleisis and 114 patients (39.9%) underwent partial colpocleisis. Totally 48 patients (16.8%) in 286 patients underwent anti-urinary incontinence procedure. The mean operating time of 286 patients was (67±22) minutes,the mean blood loss was (52± 57) ml, the mean hospital stay after surgery was (5.9±1.9) days (2-16 days) . The rate of postoperative complications was 8.7% (25/286) . Those complications including 1 case of bladder injury during operation, 3 cases of postoperative pelvic hematoma, 1 case of intestinal obstruction, 5 cases of atrial fibrillation, 10 cases of postoperative morbidity, 3 cases of pulmonary embolism, 1 case of lower limb thrombosis, 1 case of urinary retention underwent electrical stimulation treatment because of ineffective application of urinary retention catheter. The mean operating time was (67±22) minutes in total colpocleisis and (68±20) minutes in partial colpocleisis (P>0.05) , the mean blood loss was (58±62) ml in total colpocleisis and (41±45) ml in partial colpocleisis (P>0.05) , the mean hospital stay after surgery was (5.9±1.9) days in total colpocleisis and (6.0±1.8) days in partial colpocleisis (P>0.05) , the rate of post operative complications was 8.1%(14/172) in total colpocleisis and 9.6% (11/114) in partial colpocleisis (P>0.05) , respectively;those four of comparisons showed no significant difference. There were 129 patients (45.1%, 129/286) with voiding difficulty before surgery;the mean postvoid residual volumes of the above two operation types of people after operation were (35±43) and (34±41) ml, which showed no significant difference (P>0.05) .ConclusionsColpocleisis is a safe and effective management in selected elderly patients with severe POP, who no longer desire to maintain vaginal coital function. There is no significant difference in the perioperative period conditions between total and partial colpocleisis. The choice of surgical procedure is based on factors such as the presence or absence of malignancy in the uterus, age and willingness of the patient, and general condition.