阴式中盆腔重建术治疗以中盆腔缺陷为主的盆腔器官脱垂临床疗效研究

Study on the clinical efficacy of transvaginal middle pelvic reconstruction for pelvic organ prolapse patients characterized by middle compartment defects

目的探讨阴式中盆腔重建术治疗以中盆腔缺陷为主的盆腔器官脱垂(POP)的临床疗效。方法回顾性分析2012年1月至2014年6月在中国医科大学附属盛京医院因以中盆腔缺陷为主的盆腔器官脱垂需要手术治疗的68例患者的临床资料,按手术术式不同进行分组:48例行阴式中盆腔重建术,20例行腹腔镜下阴道骶骨固定术。分别于术后3、6、12个月门诊复查。结果 48例采用阴式中盆腔重建术患者术后均未见复发,POP量化分级(POP-Q)测定各指示点均在正常范围,客观治愈率达100%,主观症状复发2例,主观治愈率95.8%;20例采用腹腔镜下阴道骶骨固定术患者中,术后复发3例,POP-Q评分均为Ⅱ度,复发部位主要为阴道后壁,客观治愈率85%,主观症状复发4例,包括膀胱排空有困难,压力性尿失禁等,主观治愈率80%,差异有统计学意义(P<0.05)。结论阴式中盆腔重建术在治疗以中盆腔缺陷为主的盆腔器官脱垂上疗效明确,主、客观治愈率均优于腹腔镜下阴道骶骨固定术。

Objective To discuss the clinical curative effect of transvaginal middle pelvic reconstruction for pelvic or- gan prolapse patients characterized by middle compartment defects. Methods This was a retrospective cohort study in 68 pelvic floor dysfunction patients in Shengjing Hospital of China Medical University from January 2012 to June 2014. They were grouped by different surgical operation,48 patients were cured by transvaginal middle pelvic reconstruction, and other 20 patients were cured by laparoscopic sacroeolpopexy. They were re-examined after 3 months, 6 months and 12 months in outpatient department.Results There were no recurrence cases in transvaginal middle pelvic reconstruc- tion group, they were all staged 0 by international POP-Q scoring criteria, and the cure rate was 100%. There were three recurrence cases that staged Ⅱ in the laparoscopic sacrocolpopexy group,the recurrence site were primarily in the poste- rior vaginal wall, and the cure rate was 85% （P 〈 0.05）.Conclusion The clinical results suggest that transvaginal mid- dle pelvic reconstructiont has definite effect in the repair for pelvic organ prolapse.