全盆底悬吊术治疗围绝经期盆腔器官脱垂的疗效研究

Effect study of total pelvic floor sling operation in perimenopausal patients with pelvic organ prolapse

目的评价全盆底悬吊术治疗盆腔器官脱垂的手术疗效及术后生活质量。方法 2010年1月~2012年12月,在新疆医科大学第一附属医院妇科收治的盆腔器官脱垂患者中,纳入年龄40~60岁、盆腔器官脱垂-Q分期Ⅱ度及以上、行全盆底悬吊术者,共80例。手术前全面评估手术耐受性、盆腔器官脱垂程度及患者尿失禁情况。记录围术期指标。设计生活质量调查表,共包括15项症状,根据症状对患者日常生活影响的程度进行评分,3分为没有影响、2分为轻度影响、1分为中度影响、0分为重度影响。分别于术前、术后6个月及术后1年进行评估。采用重复测量方差分析进行统计学分析。结果 80例患者均无膀胱、直肠、血管及神经等损伤。手术时间为(75.2±3.1)分钟,术中出血量(89.8±31.8)ml,住院时间(7.5±1.3)天。术后6个月及1年随访,无1例发生网片侵蚀并发症。15项症状评分合计,术前为(18.19±0.41)分、术后6个月为(38.59±0.26)分、术后1年为(39.94±0.30)分,术后评分明显高于术前(重复测量方差分析F值为1 837.686,P=0.000)。各项症状分别评分,术后6个月和术后1年的结果也明显高于术前,差异均有统计学意义(P值均﹤0.05)。结论全盆底悬吊术治疗围绝经期盆腔器官脱垂的创伤小,疗效好,安全性高,可明显改善患者的近期生活质量。

Objective To evaluate the effect and post-operation life quality of pelvic organ prolapse treated by total pelvic floor sling operation. Methods From January 2010 to December 2012, among the patients with pelvic organ prolapse admitted in the department of gynaecology of The First Affiliated Hospital of Xinjiang Medical University, a total of 80 cases who were 40-60 years old, were II degree and above of pelvic organ prolapse -Q stage and undergone total pelvic floor sling operation were included in this study. Operation tolerance, pelvic organ prolapse degree and condition of patients＇ urinary incontinence were comprehensively evaluated before operation. Perioperative indicators were recorded. Questionnaire of quality of life was designed and totally 15 symptoms were included. According to the degree of the impact on patients＇ daily life, the score was graded, 3 points with no influence, 2 points with mild influence, 1 point with moderate influence and 0 point with sever influence. Respectively in the preoperative, 6 months and 1 year after surgery period, the evaluations were conducted. Statistical analysis was performed by repeated measurement of variance. Results 80 patients had no injury of bladder, rectum, blood vessels and nerve. Operative time was （75.2 ± 3.1） min. Volume of intraoperative bleeding was （89.8 ±31.8） ml. Hospital stays were （7.5 ± 1.3） days. Follow-up of 6 months and 1 year after surgery, no mesh erosion complications occurred. Summation of 15 symptoms, the score before operation were （18.19 ± 0.41） points, （38.59 ± 0.26） points at 6 months after operation and （39.94 ± 0.30） points at 1 year after opration. Postoperative scores were significantly higher than preoperative scores （repeated measurements analysis of variance F value was 1 837.686, P= 0.000）. Moreover, any symptom score of 6 months and 1 year after surgery were higher than that of preoperative. The difference was statistically significant （ all P 〈0.05 ） . Conclusions Total pelvic floor sling operation treating pelvic organ prolapse has the advantages of lesser trauma, better effect and high safety, which can obviously improve the patient＇s recent life quality.