育龄子宫脱垂妇女微创高位宫骶韧带悬吊联合宫颈截除手术的效果研究

Laparoscopic high uterosacral ligament suspension combined with cervical amputation in treatment of women severe uterine prolapsed at child-bearing period

目的探讨已婚育龄子宫脱垂妇女行微创高位宫骶韧带悬吊联合宫颈截除手术的短期和长期效果。方法共纳入50例荆州市中心医院诊断为Ⅲ度以上子宫脱垂妇女作为研究对象,采用随机数字法平均分为观察组与对照组,分别给予微创高位宫骶韧带悬吊联合宫颈截除手术治疗与单独微创高位宫骶韧带悬吊治疗,术后随访3年,比较两组盆腔器官脱垂定量分度法(POP-Q)评估差异,并采用中文版健康调查简表(SF-36)与盆腔器官脱垂/尿失禁性功能问卷(PISQ-12)对其远期生活质量及性功能进行评价。结果术后6个月观察组无阴道肿物脱出,下坠感均有明显好转,而对照组有1例出现阴道肿物脱出,3例有明显下坠感;术后均无输尿管扭曲、膀胱或直肠损伤、盆腔血肿等并发症。术后两组患者除阴道总长度(TVL)外,其余POP-Q各指示点位置与术前比较差异均有统计学意义(P<0.05);且观察组距处女膜3cm的阴道前壁处、宫颈或子宫切除的阴道残端及后穹窿(未切除子宫者)指示点位置明显好于对照组,差异有统计学意义(P<0.05)。术后两组患者SF-36评分及PISQ-12评分均有明显改善,与术前相比差异有统计学意义(P<0.05),且观察组情感得分较对照组改善更明显(P<0.05)。结论微创高位宫骶韧带悬吊联合宫颈截除手术可以有效改善已婚育龄子宫脱垂妇女临床症状。

Objective To evaluate clinical and sexual outcomes in women with severe uterine prolapsed at child-bearing period undergoing laparoscopic high uterosacral ligament suspension combined with cervical amputation. Methods Fifty patients with severe uterine prolapse were included. All patients were divided into observation group and control group. Patients in observation group were given laparoscopic high uterosacral ligament suspension combined with cervical amputation, and patients in control group were given laparoscopie high uterosacral ligament. Anatomic failure was defined as≥1 pelvic compartment classified as POP- Q≥stage Ⅲ. Sexual outcomes were assessed at baseline and 3-year follow-up according to validated Short-Form Prolapse/Urinary Incontinence Sexual Questionnaire（PISQ-12）. Results There were no patients with postoperative vaginal lesions emerge or straining feeling. There were 3 patients with straining feeling and 1 patients with postoperative vaginal lesions emerge. The POP-Q were better postoperative than that preoperative. The difference were statistically significant（P〈0.05）. The Aa, C and D instructions point in observation group were better than that in control group. The difference were statistically significant（P〈0.05）. The SF-36 scale and PISQ-12 scores were better postoperative than that preoperative. The difference were statistically significant （P〈0.05）. The emotion scores in observation group were better than that in control group. The difference were statistically significant （P〈0.05）. Conclusion Laparoscopic high uterosacral ligament suspension combined with cervical amputation conferred satisfying longterm anatomic and sexual function outcomes in women at child-bearing age.