阴道封闭术治疗老年女性重度盆腔器官脱垂的临床疗效和生活质量评价

Clinical Efficacy and Life Quality Evaluation of Colpocleisis for Severe Pelvic Organ Prolapse in Elderly Women

目的探讨阴道封闭术治疗老年女性重度盆腔器官脱垂（pelvic organ prolapse,POP）的疗效和安全性。方法回顾性分析我院2011年1月～2014年5月101例老年女性因重度POP行阴道全封闭术或改良阴道半封闭术且完成随访的临床资料,POP定量分度（POP-Q）法分期为Ⅲ～Ⅳ期,评价手术的主客观效果、患者满意度和主客观复发情况,术前后采用PFDI-20短表调查生活质量。结果手术时间（120.9±37.8）min,术中出血量中位数100 ml（10～1100 ml）,无围手术期并发症,顺利恢复自主排尿。中位随访时间24个月（7～47个月）,2例术后2年复发,均为Ⅱ期,1例无临床症状未做任何处理,1例自觉略有摩擦感,再次手术治愈。客观治愈为98.0%（99/101）,主观治愈率为99.0%（100/101）,对手术效果的总体满意程度为99.0%（100/101）。术后生活质量评分（PFDI-20总评分）中位数0分（0～88.5分）,术前PFDI-20评分中位数83.3分（12.5～177.1分）,术后较术前显著改善（Z=-8.639,P=0.000）。结论阴道封闭术对于无性生活要求的老年女性重度POP患者是一种安全的术式,显著改善患者生活质量。

Objective To evaluate the efficacy and safety of colpocleisis in the treatment of severe pelvic organ prolapse（ POP） in elderly women. Methods A retrospective study was conducted on 101 elderly patients with POP（ stage Ⅲ- Ⅳ by POP-Q staging） receiving total or partial colpocleisis in our hospital from May 2011 and May 2014. The subjective and objective efficacy,patients＇ satisfaction,and recurrence were evaluated. The preoperative and postoperative quality of life（ QOL） were evaluated by using the PFDI-20. Results The operation time was（ 120. 9 ± 37. 8） min. The median blood loss was 100 ml（ range,10- 1100 ml）. No perioperative complications occurred. Autonomous urination was recovered in all the patients. The median followup time was 24 months（ range,7- 47 months）. Recurrence（ stage Ⅱ） was found in 2 patients at the 2nd postoperative year. One of them had no clinical symptoms and was untreated. Another patient felt mild friction sensation and underwent a re-operation for cure.The objective cure rate was 98. 0%（ 98 /101）. The subjective cure rate was 99. 0%（ 99 /101）. Patients＇ satisfaction rate was 99. 0%（ 99 /101）. Patients＇ QOL with PFDI-20 scores was 0- 88. 5 points（ median,0 point） postoperatively and 12. 5- 177. 1 points（ median,83. 3 points） preoperatively,with significant difference（ Z =- 8. 639,P = 0. 000）. Conclusions Colpocleisis is a safe and economical operation for the elderly patients with severe POP. It provides a significant improvement of QOL of patients.