不同手术方式在症状性盆腔器官脱垂患者中的应用及疗效分析

Analysis of the Application and Effect of Different Surgical Methods in Patients with Symptomatic Pelvic Organ Prolapsed

目的:分析因症状性盆腔器官脱垂(POP)接受手术治疗患者的临床资料,探讨不同手术方式的疗效及临床应用。方法:选择2010年7月至2014年12月在青岛大学附属医院因POP接受手术治疗的176例患者为研究对象,其中全盆底重建术97例,阴道骶骨固定术22例,传统手术(经阴子宫切除+阴道壁修补术)57例。回顾性分析不同术式患者的临床资料、手术疗效及病人生活质量评分及性生活影响等相关资料。结果:1三组手术患者在手术时间、出血量及住院费用上均存在不同的差别。其中盆底重建组手术时间及出血量明显低于传统手术组及骶骨固定组(P=0.00)。2176例患者中有163例患者完成术后12个月随访。其中传统手术组患者的客观治愈率低于其他两组患者,差异有统计学意义(P<0.05)。3三种术式术后6、12个月PFDI-20评分均较术前下降,且差异有统计学意义(P<0.05),三组间术前及术后6个月PFDI-20评分比较无差异;术后12个月传统手术组评分高于其他两组,差异有统计学意义(P<0.05)。4在术后恢复性生活的患者当中,盆底重建组及传统组中有患者出现不同程度的性交痛,而骶骨固定组其性生活较前术前明显改善,三组间差异有统计学意义(P<0.05)。三组患者术后新发尿失禁的比率无统计学意义。结论:三种术式各具优缺点,但均为症状性POP的有效治疗方式。在临床应用中,要综合评估患者的年龄、合并症、性生活要求及经济情况等,制定和选择最合理的个体化方案。

Objective： To analysis the characteristics of symptomatic pelvic organ prolapse （POP） who underwent surgical treatment and to investigate the clinical effect and application of different surgical methods. Methods： This study selected 176 patients with POP who had received surgical treatment in Affiliated Hospital of Qingdao University from July 2010 to December 2014. They received different operation methods. 97 cases were cured total pelvic floor reconstruction. 22 cases were cured by sacral colpopexy （SC）, 57 cases were cured by traditional surgery （transvaginal hysterectomy plus repair of vaginal anterior and posterior wall. Analyze the clinical materials, recoery after operation, curative effect and complications of these 176 patiens, get the recurrence rate and quality of life, and carry on statistics to get significance. Results： （1）There had significant difference of operation time, intraoperative blood loss, hospitalization costs among three groups. The time of operation and amount of bleeding in pelvic floor reconstruction group significantly lower than SC group and traditional group. The cost of hospitalization in pelvic floor reconstruction group was least. （2）In 163 patients completed 12 months follow-up after surgery. The objective cure rate of patients with traditional surgery is lower than the other two groups. （3）Scores of PFDI-20 in three groups at 6 months and 12 months after the operation compared with the preoperative score were significantly different （P〈0.05）. There had no significant difference of PFDI-20 before and after the operation in six months （P〉0.05） among three groups, but in the 12 months after the operation, the score of traditional group was higher than the other three groups （P〈0. 05）. （4）There are patients who were sexually active suffered dyspareunia in reconstruction group and traditional group. However, the quality of sexual life was improved compared with preoperative in SC group. In three groups, there had no significant difference of the ratio of postoperative urinary incontinence. Conclusion： These three modes of operation have their own advantages and disadvantages. However, three operation methods are effective ways in the treatment of severe POP. To evaluate the patient＇s age and comorbidit and requirements for sexual life, economic situation in clinical application, formulate and choose the most reasonable individual program.