改良式腹腔镜子宫骶骨固定术治疗子宫脱垂临床分析

Clinical analysis of improved laparoscopic sacral colpopexy for treating uterine prolapse

目的探讨改良式腹腔镜子宫骶骨固定术治疗子宫脱垂的临床疗效。方法回顾分析2013年6月至2014年7月江西省妇幼保健院行腹腔镜子宫骶骨固定术的32例患者的临床资料,其中15例行改良式腹腔镜子宫骶骨固定术(改良组),17例行传统式腹腔镜子宫骶骨固定术(传统组)。比较两组患者的手术时间、术中出血量、住院天数及术后并发症,术后12个月测量患者POP-Q各点数值以评价术后盆底功能改善状况,以盆底不适调查表短表20(PFDI-20)评价手术前后患者的生活质量。结果 32例患者均经腹腔镜成功完成手术,术中无膀胱、输尿管、直肠损伤,无盆腔腹膜后血肿、肠梗阻等。改良组的手术时间、术中出血量、住院天数均少于传统组,差异有统计学意义(P<0.05)。术后随访12个月,两组患者均无子宫脱垂复发和阴道壁脱垂,POP-Q各点测量值差异无统计学意义(P>0.05);两组的术前与术后生活质量调查表问卷得分比较,差异无统计学意义(P>0.05)。改良组术后出现1例中重度腰痛,传统组术后出现1例术后下肢静脉血栓,1例阴道网片暴露。结论腹腔镜子宫骶骨固定术治疗子宫脱垂安全有效;改良式腹腔镜子宫骶骨固定术具有手术操作简单、手术时间短、术中出血量少、术后并发症少等优点,适合临床推广。

Objective To explore the surgical skills and clinical effectiveness of improved laparoscopic sacral colpopexy（ LSC）by using synthetic mesh in the treatment of uterine prolapse. Methods A retrospective analysis of 32 patients with uterine prolapse who received LSC in Jiangxi Province Women and Children Health Care Hospital from JAN 2014 to JUL 2014 was conducted. Among 32 patients,15 cases received improved LSC（ improved group） and 17 cases received traditional LSC（ traditional group）. The operation time,blood loss,hospital stay and complications of the two groups were compared 12 months after the operation,measured the POP-Q value at every point to assess postoperative pelvic floor function and evaluated preoperative and postoperative quality of life by using the pelvic floor distress inventory（ PFDI- 20）. Results All procedures were successfully completed by laparoscopic therapy. The operation time,blood loss,hospital stay of the improved group were less than those of the traditional group,the differences were statistical significance（ P〈0. 05）. 12 months after surgery,none of the women had recurrent uterine prolapse. The difference of the POP- Q value at every point between two groups had no statistical significance（ P〉0. 05）. The two groups both have improvement in the uterine prolapse,the difference of urinary subscales of the pelvic floor distress inventory between two groups had no statistical significance（ P〉0. 05）. Conclusion The two types of surgery for uterine prolapse are both effective. The improved LSC has the advantages of small trauma,less bleeding,faster recovery,it is expected to be promoted in clinic.