阴道残端悬吊术在全子宫切除中的疗效分析

Curative effect of vaginal suspension during laparoscopically total hysterectomy

目的 回顾性分析腹腔镜下全子宫切除术后,附加阴道残端悬吊术在非脱垂全子宫切除术中预防术后盆底功能障碍及改善患者心理因素的临床疗效.方法 选取符合全子宫切除术指征的良性疾病且不合并子宫脱垂的患者351例,其中198例行腹腔镜下子宫全切术且术中附加阴道残端悬吊术（悬吊组）,153例仅行单纯性腹腔镜下子宫全切术（对照组）,两组均无中转开腹,对比术后近期、远期疗效及患者心理改变,两组患者术后均未接受其他特殊盆底方面治疗.结果 平均随访时间 34.5个月,两组手术总时间、术中出血量、术后住院时间及拔除导尿管时间,阴道湿度及更年期症状的出现等情况比较差异未见统计学意义（P〉0.05）.两组均定期随访,术后阴道残端愈合情况、阴道残端脱垂发生率、尿失禁发生率、阴道长度及性生活满意度等方面两组比较差异有统计学意义。

Objective To retrospectively analyze the clinical efficacy of vaginal suspension during laparoscopically total hysterectomy on precaution the pelvic floor dysfunction after operation.Methods Selected 351 patients diagnosed as benign disease but not merge uterine prolapse by pathological examination treated by laparoscopic surgery, then they were divided into vaginal suspension group and matched group, 198 cases of laparoscopic uterine total resection operation and intraoperative additional vaginal stump suspension （vaginal suspension group） and 153 cases only with laparoscopic uterine total resection surgery （control group）, two groups were not converted to laparotomy, the postoperative short-term and long-term curative effect and patient＇s psychological change were compared, two groups of patients with postoperative did not accept the treatment of other special pelvic floor.Results The follow-up time was 34.5 months.There was no significant clifference in the total operative time, intraoperative blood loss, postoperative hospitalization time and remove guide catheter time, vaginal moisture and climacteric symptoms of the two groups （P〉0.05）.Two groups were followed up regularly for vaginal stump healing rate, urinary incontinence incidence, length of vagina, sexual satisfaction etc, the differences were significant （P〈0.05）.Compared with the control group, the quality of life of the patients in the suspension group was significantly improved.Conclusions Laparoscopic non prolapsed uterus resection, additional vagina suspention, is significantly for the postoperative recovery and its complications prevention effect is very significant, so it is a kind of superiority and high safety factor of operation, it is worth of clinical practice.