骶主韧带复合体-耻骨阴道肌交叉缝合联合骶棘韧带悬吊术治疗重度盆腔器官脱垂48例分析

Clinical analysis of cross-stitching of the uterosacral-cardinal ligament complex and pubovaginalis muscle combined with sacrospinous ligament fixation in treating 48 cases of severe pelvic organ prolapse

目的探讨骶主韧带复合体-耻骨阴道肌交叉缝合术联合骶棘韧带悬吊术治疗重度盆腔器官脱垂的临床应用价值。方法回顾性分析2012年5月至2015年1月于南方医科大学附属佛山市妇幼保健院应用骶主韧带复合体-耻骨阴道肌交叉缝合术联合骶棘韧带悬吊术治疗48例重度盆腔器官脱垂患者的临床资料。48例盆腔器官脱垂患者均以中盆腔、前盆腔缺陷为主,盆腔器官脱垂定量(pelvic organ prolapse quantification,POP-Q)分期均为Ⅲ期以上,均行经阴道全子宫切除术+骶主韧带复合体-耻骨阴道肌交叉缝合术+骶棘韧带悬吊术+阴道后壁修补术+会阴裂伤修补术,5例(10.4%,5/48)术前有压力性尿失禁者同时行经闭孔无张力尿道中段悬吊带术。术后对患者的主、客观疗效进行分析,包括围手术期情况以及近远期并发症。结果 48例患者手术时间(95±20)min,失血量(150±50)m L,随访时间(22±12)个月。随访时间内1例患者解剖学复发,客观治愈率为97.9%(47/48),主观满意度为97.9%(47/48),PFDI-20、PFIQ-7调查问卷中位评分分别为5、6分,均较术前(分别为65、67分)明显降低(P<0.01)。术后3 d1例患者(2.1%,1/48)出现尿量减少,予拆除骶主韧带复合体-耻骨阴道肌交叉缝合缝线后排尿恢复正常。结论骶主韧带复合体-耻骨阴道肌交叉缝合术联合骶棘韧带悬吊术治疗重度盆腔器官脱垂主、客观治愈率高,且简单、安全、有效,值得在临床推广运用。

Objective To discuss the clinical value of the cross-stitching of the uterosacral-cardinal ligament complex and pubovaginalis muscle combined with saerospinous ligament fixation（CUCLCPM-SSLF） in treating severe pelvic or- gan prolapse（POP）. Methods The clinical data of 48 cases of severe POP,who were treated mainly with CUCLCPM- SSLF between May 2012 and Jan. 2015 in Maternal and Child Health Hospital of Foshan City affiliated to Southern Med- ical University,were retrospectively analyzed.All patients manifested as primarily anterior and middle compartment de- fects, stage III or higher according to Pelvic Organ Prolapse Quantification（POP-Q） system,and were treated by the transvaginal hysterectomy, anterior and posterior colporrhaphy and repair of perineal laceration besides CUCLCPM- SSLF.Five in 48 cases（10.4%,5/48） with preoperative stress urinary incontinenee（SUI） had concurrent transobturator vagi- nal tape（TVT-O）. The postoperative subjective and objective data of the patients were retrospectively analyzed,including perioperative situations and the short-term and long-term complications.Results The average operative time was （95＋ 20）min ,and average blood loss was （150＋50）mL.The average follow-up time was （22_＋ 12） months.Both the objective cure rate and subjective satisfaction rate were 97.9% （47/48）, with one patient experiencing anatomic recurrence during the follow-up.The postoperative median score of pelvic floor distress inventory-short form 20（PFDI-20） and pel- vic floor impact questionnaire-short form 7（PFIQ-7） was 5 and 6, respectively,which decreased significantly compared to the preoperative one,which was 65 and 67,respectively （P〈0.01）.One patient（2.1%,l/48） suffered from dysuria three days after surgery and recovered after the removal of the cross-stitching.Conclusion The combination of the cross-stitching of the uterosacral-cardinal ligament complex and pubovaginalis muscle with sacrospinous ligament fixation can achieve considerable subjective and objective cure rates in treating severe POP.As it has been proved to be simple, safe and effective, this complex surgery merits extensive clinical application.