腹腔镜子宫韧带悬吊术联合阴式子宫颈截除术加主韧带缩短术在严重子宫脱垂治疗中的应用

Laparoscopic uterine ligament suspension combined with vaginal application type cervical resection plus ligament surgery in shortening the treatment of severe uterine prolapse

目的观察腹腔镜子宫韧带悬吊术联合阴式子宫颈截除术加主韧带缩短术在严重子宫脱垂治疗中的应用价值。方法选取2012年3月—2014年4月于嘉应学院医学院附属医院妇产科收治的子宫垂患者60例为研究对象,随机数字表法分为2组,每组30例,对照组给予常规阴式子宫切除术,研究组给予腹腔镜子宫韧带悬吊术联合阴式子宫颈截除术加主韧带缩短术,对2组患者的手术相关指标、治疗效果、复发情况、并发症以及术后的生活质量进行比较。结果研究组患者的手术时间显著长于对照组患者,但术中出血量、术后住院时间均显著少/短于对照组患者(t=9.440、17.042、4.124,P<0.01);研究组患者的治疗有效率显著高于对照组(x^2=4.286,P<0.05),研究组患者术后2年复发率均显著低于对照组(t=4.286,P<0.05);研究组患者的并发症总发生率均显著低于对照组(t=4.043,P<0.05);研究组患者术后PFDI-20、PQ-7评分均显著低于对照组[(0.36±0.15)分vs.(52.67±3.12)分vs.(4.67±2.16)分vs.(40.23±10.32)分],差异具有统计学意义(t=91.725、18.473、4.096,P<0.01),观察者的PISQ-12评分显著高于对照组[(102.45±25.89)分vs.(77.89±20.21)分],差异均具有统计学意义(t=4.096,P<0.05)。结论腹腔镜子宫韧带悬吊术联合阴式子宫颈截除术加主韧带缩短术在治疗子宫脱垂的应用,有助于提高严重子宫脱垂患者的治疗效果和生活质量,值得推广应用。

Objective To observe laparoscopic uterine ligament suspension combined with application value of transvaginal cervical resection plus ligament surgery in shortening the treatment of severe uterine prolapse.Methods From March2012 to April 2014,in the Affiliated Hospital of Jiaying University School of medicine,60 cases of patients with uterine vertical were enrolled as the research object,they were randomly divided into 2 groups,30 cases in each group,the control group was given routine vaginal hysterectomy,the study group was given laparoscopic uterine ligament suspension combined with vaginal cervical resection operation and main ligament shortening,2 groups of patients with surgery related indicators,curative effect,recurrence,complications and postoperative quality of life were compared.Results The operation time of patients in the study group was significantly longer than patients in the control group,but the amount of bleeding during operation,hospitalization time were significantly less and shorter than that of the control group（t = 9.440,t = 17.042,t = 4.124,P〈0.01）;the treatment of patients in the study group,the effective rate was significantly higher than the control group（χ^2=4.286,P〈0.05）,the study group patients after operation the 2 year recurrence rate were significantly lower than the control group（t =4.286,P〈0.05）;patients in the study group,the incidence of complications were significantly lower than the control group（t =4.043,P〈0.05）;the study group patients with postoperative PFDI 20,PFIQ 7 was significantly lower than the control group[（0.36 ±0.15） vs.（52.67 ±3.12） vs.（4.67±2.16） vs.（40.23 ± 10.32） points],the difference was statistically significant（t =91.725,t=18.473,t =4.096,P〈0.01）,the observer of P1 SQ 12 was significantly higher than that of control group[（102.45 ±25.89） vs.（77.89 ±20.21） points,]difference All had statistical significance（t =4.096,P〈0.05）.Conclusion Laparoscopic uterine ligament suspension combined with vaginal cervical resection plus ligament shortening in the application for the treatment of uterine prolapse,help to improve the patients with severe uterine prolapse treatment and quality of life,it is worthy of popularization and application.