盆底重建术时保留子宫与切除子宫的疗效对比研究

Comparative research of curative effects by whole pelvic floor reconstruction surgery with reserved uterine and hysterectomy

目的探讨盆底重建术时保留子宫与切除子宫的疗效。方法 100例子宫阴道脱垂Ⅲ~Ⅳ度患者,均行全盆底重建术。将患者分为实验组和对照组,每组50例。其中实验组患者行保留子宫的全盆底重建术,对照组患者行切除子宫的全盆底重建术。比较两组的术中出血量、手术时间、术后排气时间、住院时间、术后阴道长度、性生活满意度、腹痛情况及术后1年的脱垂复发率。结果实验组患者术中出血量为(120±20)ml、手术时间为(80±20)min、术后排气时间为(25±5)h、住院时间为(5±1)d,均少于对照组的(200±21)ml、(120±10)min、(40±2)h、(10±2)d,差异有统计学意义(P<0.05)。实验组患者术后阴道长度为(8.6±1.4)cm,术后性生活满意40例,术后腹痛2例,术后1年脱垂复发1例,对照组患者术后阴道长度为(5.5±1.2)cm,术后性生活满意25例,术后腹痛12例,术后1年脱垂复发2例,实验组患者术后阴道长度长于对照组(P<0.05);实验组患者术后性生活满意例数多于对照组,术后腹痛发生例数少于对照组(P<0.05)。两组患者术后1年脱垂复发情况比较差异无统计学意义(P>0.05)。结论盆底重建术治疗子宫阴道脱垂复发率低,保留子宫的全盆底重建术较切除子宫的全盆底重建术出血更少,手术更快,排气更早,住院时间短,术后阴道长度更长,性生活满意度更高,极少出现腹痛情况,值得临床推广。

Objective To investigate curative effects by whole pelvic floor reconstruction surgery with reserved uterine and hysterectomy. Methods A total of 100 patients with grade Ⅲ ~ Ⅳ uterine vaginal prolapse all received whole pelvic floor reconstruction surgery, and they were divided into experimental group and control group, with 50 cases in each group. The experimental group received whole pelvic floor reconstruction surgery with reserved uterine,and the control group received whole pelvic floor reconstruction surgery with hysterectomy. Comparison was made on intraoperative bleeding volume, operation time, postoperative exhaust time, hospital stay time, postoperative vaginal length, sexual life satisfaction, abdominal pain status and postoperative 1-year recurrence rate of prolapse between the two groups. Results The experimental group had intraoperative bleeding volume as (120±20) ml, operation timeas (80±20) min, postoperative exhaust time as (25±5) h, and hospital stay time as (5±1) d, which were all less than(200±21) ml, (120±10) min, (40±2) h and (10±2) d in the control group. The difference had statistical significance(P<0.05). The experimental group had postoperative vaginal length as (8.6±1.4) cm, 40 cases with satisfactory postoperative sexual life, 2 cases with postoperative abdominal pain and 1 case with postoperative 1-year recurrentprolapse. The control group had postoperative vaginal length as (5.5±1.2) cm, 25 cases with satisfactory postoperativesexual life, 12 cases with postoperative abdominal pain and 2 case with postoperative 1-year recurrent prolapse. Theexperimental group had longer postoperative vaginal length than the control group (P<0.05), and it had more cases withsatisfactory postoperative sexual life and less cases with postoperative abdominal pain than the control group (P<0.05).There was no statistically significant difference of postoperative 1-year recurrent prolapse status between the two groups(P>0.05). Conclusion Pelvic floor reconstruction surgery shows low recurrence rate in treating uterine vaginal prolapse.Comparing with whole pelvic floor reconstruction surgery with hysterectomy, whole pelvic floor reconstruction surgery with reserved uterine provides less bleeding volume, quicker operation, earlier exhaust, shorter hospital stay time, longer postoperative vaginal length, higher sexual life satisfaction and less case with abdominal pain. This method is worth clinical promotion.