腹腔镜下阴道残端补片悬吊术治疗盆腔脏器脱垂22例临床分析

Clinical analysis of 22 cases of pelvic organ prolapse treated by laparoscopic vaginal stump suspension with mesh

目的探讨腹腔镜下阴道残端补片悬吊术治疗盆腔脏器脱垂的疗效及安全性。方法回顾性分析安徽省立医院2012年1月至2016年1月采用腹腔镜下阴道残端补片悬吊术治疗的22例患者临床资料,其中5例子宫全切除术后阴道残端脱垂,17例子宫阴道脱垂合并子宫良性疾病须行子宫切除患者,分析患者的一般资料、脱垂程度、围术期参数和手术并发症,术后定期随访,评价主客观治愈率。结果患者年龄44~77岁,平均（62.15±8.77）岁,均为经产妇。采用POP-Q定量分度,Ⅱ度共有2例,Ⅲ度共16例,Ⅳ共4例;手术时间为95~250 min,平均（155.22±46.41）min,术中出血量10~150 ml,平均（64.41±38.15）ml,无手术其他脏器损伤、死亡,术后1例患者出现切口感染,给予积极抗炎补液处理后痊愈。术后随访9~48个月,22例患者全部治愈,无复发。生命质量调查中手术前盆底功能障碍问卷简表（PFDI-20）、盆底功能影响问卷简表（PFIQ-7）较术后6个月、1年相比差异均有统计学意义（P〈0.05）,性生活质量问卷评分（PISQ-12）差异均无统计学意义（P〉0.05）,患者主客观治愈率100%。结论腹腔镜下阴道残端补片悬吊能有效缓解患者盆腔脏器脱垂的症状,改善术后生活质量,效果满意,值得推广。

Objective To evaluate the efficacy and safety of laparoscopic vaginal stumping with mesh in the treatment of pelvic organ prolapse.Methods The clinical data of 22 patients treated with laparoscopic vaginal stump suspension from Jan 2012 To Jan 2016 in Anhui Province Hospital were analyzed retrospectively.Among the 22 patients,5 cases had vaginal stump prolapse after total hysterectomy,17 cases had uterine and vaginal prolapse combined with benign uterine disease and underwent hysterectomy.The general information,the degree of prolapse,perioperative parameters and surgical complications were analyzed.Regular follow-up was made after surgery to evaluate subjective and objective cure rate.Results Patients are all multiparas,aged from 44 to 77 years [average（62.16±8.77） years].The prolapse was staged as Ⅱ in 2 cases,Ⅲ in 16 cases and Ⅳ in 4 cases according to the POP-Q quantitative grading.The operation time were 95 to 250 min [average（155.22＋46.41） min],intraoperative blood loss were 10 to 150 ml [average（64.41＋38.15） ml].No other organ injury or death occurred and only one incision infection after the operation.All patients were followed up for 9~48 months and cured without recurrence.The quality of life questionnaire（PFDI-20） and the pelvic floor function influencing questionnaire（PFIQ-7） before surgery were significantly lower than six-month and one year follow-up.The quality of sexual life questionnaire（PISQ-12） score was not statistically significant.The subjective and objective cure rate of patients underwent laparoscopic vaginal stump suspension were 100%.Conclusions Laparoscopic vaginal stump suspension could effectively relieve symptoms of pelvic organ prolapse and improve the quality of postoperative life,with a satisfied effect.The Laparoscopic vaginal stump suspension has certain worthy of promotion.