宫杯辅助下腹腔镜骶骨阴道固定术与全盆底重建术两种治疗方案在盆腔器官脱垂患者中的疗效比较

Comparison of the efficacy of curette assist laparoscopic sacrocolpopexy and total vaginal mesh in the treatment of patients with pelvic organ prolapse

目的对比观察宫杯辅助下腹腔镜骶骨阴道固定术(CALS)与全盆底重建术(TVM)治疗盆腔器官脱垂患者中的临床疗效。方法回顾性分析2012年11月至2015年2月收治的94例盆腔器官脱垂患者,按照患者意愿分为CALS组(40例)和TVM组(54例)。比较两组患者手术时间、术中出血量、术后尿管留置时间以及住院时间等指标;评价术后盆腔指示点解剖恢复情况,客观治愈率以及复发率,手术前后生活质量评价。结果两组患者手术时间、术后留置尿管时间、住院时间比较无统计学差异(P>0.05);CALS组患者术中出血量明显少于TVM组患者(P<0.05);两组患者Aa、Ba、C、Ap、Bp指示点术后6月同术前比较,差异有统计学意义(P<0.05);TVL术前与术后6月比较无统计学差异(P>0.05);CALS组患者客观治愈率明显高于TVM组,术后6周复发率低于TVM组,差异均有统计学意义(P<0.05);两组患者术后6月生活质量较术前明显改善,且CALS组术后生活质量改善情况明显优于TVM组患者,差异有统计学意义(P<0.05)。结论 CALS和TVM均能有效恢复POP患者盆腔解剖结构,CALS术中出血量少,客观治愈率高,术后复发率低,术后患者生活质量高,效果较为满意。

Objective To explore the clinical effects of curette assist laparoscopic sacrocolpopexy（ CALS） and total vaginal mesh（ TVM）in the treatment of patients with pelvic organ prolapse. Methods Retrospective analysis 94 patients of pelvic organ prolapse in our hospital from November 2012 to February 2015,and the patients were divided into CALS surgical group（ 40 cases） and TVM group（ 54 cases）. Compared operative time,blood loss,postoperative indwelling catheter time and hospital stay,evaluation of pelvic anatomy indicates the recovery point objective cure rates and relapse rates,quality of life before and after surgery. Results Operative time,postoperative indwelling catheter time,were not significantly different in the two groups（ P〈0. 05）. But there was significantly difference of blood loss in patients with CALS TVM patients（ P 0. 05）. Aa,Ba,C,Ap,Bp indicator points after six months compared with the preoperative,there were significant differences（ P〈0. 05）; and no significant difference of TVL before and after six months（ P〈0. 05）. objective cure rate of CALS was significantly higher than the group TVM,the recurrence rate was less than six weeks after with statistically significant（ P〈0. 05）. The postoperative quality of life improved significantly compared with the preoperative,intraoperative of CALS group after the improvement of quality of life was significantly better than the TVM group of patients（ P〈0. 05）. Conclusion CALS and TVM can effectively restore pelvic anatomy of POP,CALS has the advantages in blood loss,higher objective cure rate and lower recurrence rate,and high quality of life for patients,with a satisfactory effect.