保留子宫在改良盆底重建术中的中远期疗效评价

Evaluation of mid to long term clinical efficacy of uterus reserved in modified pelvic floor reconstruction

目的：比较改良盆底重建术中保留子宫与否对治疗盆底脏器脱垂（POP）的临床疗效。方法：选取从2009年3月～2012年6月本院收治的施行改良盆底重建手术的POP患者61例，其中29例术中保留了子宫（保留子宫组UC组），32例同时行阴式子宫切除术（切除子宫组CH组），评价围手术期相关情况及术后随访盆腔脏器脱垂改善情况。结果：UC组患者手术时间短、出血量少于CH组（P〈O．05）；两组组内术前及术后6个月POP—Q值比较，差异均有统计学意义（P〈O．05），组间比较差异均无统计学意义（P〉0．05）；术后平均随访时间48．7月，UC组随访率89．7％，CH组随访率84．4％；主观治愈率均100％；客观治愈率UC组92．3％、CH组92．6％，两组比较主客观治愈率差异无统计学意义（P〉O．05）。结论：改良盆底重建手术中保留或切除子宫均能有效的治疗盆底脏器脱垂情况，其中远期的临床治愈率相似，远期疗效仍需进一步观察。

Objective： To compare the clinical efficacy of uterus conservation and uterus hysterectomy in the modified pelvic reconstructive surgery in treatment patients with pelvic organ prolapse. Method： From March 2009 to June 2012 ,a total of 61 patients with pelvic organ prolapse received modified pelvic floor reconstruction surgery in Maternal and Child Health Hospital of Changning District, and 29 patients preserved the uterus （uterus preservation group, UPG）, 32 patients had vaginal hysterectomy at the same time （hysterectomy group, HG）. The perioperative situation and clinical efficacy of treating pelvie organ prolapsed postoperation for all the included patients were evaluated. Result： There were significant shorter operation time and litter operative hemorrhage of patients in UPG than those of patients in HG （P〈0.05）. There was significant difference in POP-Q score compared before operation to 6 months after opera- tion both in the two groups （P〈0.05）, however, there was no significant difference in POP-Q score before operation or 6 months after operation between the two group （P〈0.05）. The mean follow-up time was 48.7 months for all pa- tients, and the rate of follow-up in UPG and in HG was 89.7% and 84.4%, respectively. Rate of Subjective cure in both groups was 100%, but rate of objective cure in UPG and in HG was 92.3% and 92.6%, respectively. There was no significant difference in rate of subjective or objective cure between the two groups （P〈0.05）. Conclusion： The modified pelvic reconstructive surgery with uterus conservation or hysterectomy had high effectiveness in treatment of pelvic organ prolapsed. The rate of mid to long term clinical cure in the two operations is similar, but the longer cura- tive effectiveness needs further clinical observation.