子宫切除对全盆底重建疗效的影响

Influence of hysterectomy on pelvic floor reconstruction

目的：探讨子宫切除与否对全盆底重建术后疗效的影响。方法回顾性分析厦门市妇幼保健院2011年1月至2012年12月91例POP-Q分期Ⅲ～Ⅳ期盆腔器官脱垂患者行全盆底重建术（使用Prolift网片）中切除子宫与否，比较两组术后的疗效。结果切除子宫组的手术时间为（157．30±5．38）分钟，明显长于保留子宫组（132．29±11．88）分钟（t＝41．10，P＜0．001）；切除子宫组的术中出血量为（214．81±18．26）mL，也明显多于保留子宫组（187．14±48．24）mL（t＝45．47，P＜0．001）。保留子宫组术后阴道平均长度长于切除子宫组，两组比较差异有统计学意义（t＝5．45，P＜0．001）。手术后于1、3、6、12个月随访，随访率两组均为100％。两组术后治愈率为100％。切除子宫组有1例网片暴露；保留子宫组无网片暴露。两组均无膀胱、下尿路或肠道损伤，无感染和侵蚀发生，无持续性排尿、排便困难。结论盆底重建手术时保留子宫对维持盆底结构稳定具有一定的意义，近期效果与切除子宫组相似，且手术时间短，有利于降低中老年妇女围手术期的风险，提高手术耐受程度，但还需进一步随访观察长期疗效及远期并发症。

Objective To explore the influence of hysterectomy on pelvic floor reconstruction.Methods Retrospectively analysis was conducted on the clinical data of 91 cases from Xiamen Maternity and Child Health Care Hospital with pelvic organ prolapse （ POP） stagingⅢ-IV according to POP-Q between January 2011 and December 2012.All of 91 cases underwent pelvic floor reconstruction （ using Prolift mesh） , and they were divided into two groups according to undergoing hysterectomy or not.The postoperative efficacy was compared between two groups.Results The average operating time （157.30 ±5.38min） for uteri-removed group was significantly longer than that of uteri-reserved group （132.29 ±11.88min） （t=41.10,P〈0.001）.The blood loss （214.81 ±18.26mL） of the uteri-removed group was significantly more than that of the uteri-reserved group （187.14 ±48.24mL） （t=45.47, P〈0.001）.The average vaginal length of the uteri-reserved group was longer than that of the uteri-removed group, and the difference was significant （t=5.45,P〈0.001）.Two groups were followed up at 1, 3, 6 and 12 month after surgery with follow-up rate of 100%.The curative rate of both groups was 100%.There was 1 case of mesh exposure in the uteri-removed group but none in the uteri-reserved group.No injury to bladder, urinary tract or intestinal, no infection or erosion, no persistent bowel or urinating difficulties was found.Conclusion For pelvic floor reconstruction, preserving uterus, in a certain sense, maintains the stability of pelvic structure.Its short-term effect is similar to uteri-removed group but with shorter operating time, lower risk of perioperation for older women and better surgical tolerance.But further follow-up study is required to explore the long-term results and long-term complications.