腹腔镜下髂耻韧带固定术治疗盆腔脏器脱垂

Laparoscopic Pectopexy in the Treatment of Pelvic Organ Prolapse

目的探讨腹腔镜下髂耻韧带固定术治疗盆腔器官脱垂(pelvic organ prolapse,POP)的临床疗效。方法2014年11月～2017年9月我院妇科对40例POP-Q分期≥Ⅱ期、以中盆腔脱垂为主的POP行腹腔镜下髂耻韧带固定术。采用POP-Q分期法、盆底功能障碍问卷-20(PFDI-20)、盆底疾病生活质量影响问卷短表-7(PFIQ-7)、盆腔器官脱垂/尿失禁性生活质量问卷-12(PISQ-12)问卷调查评价解剖和功能疗效。结果 40例均成功完成手术,术中未出现肠管、输尿管、膀胱、血管及神经损伤。术后1～2 d拔除尿管均能自主排尿,无尿潴留。术后随访(20. 3±6. 2)月,未发现网片侵蚀、暴露等并发症。术后3个月POP-Q分期法测定均无脱垂,解剖治愈率100%。2例分别在术后12、18个月出现阴道前壁脱垂。PFIQ-7评分术前(67. 7±1. 8)分,明显高于术后末次随访(12. 2±1. 4)分(t=172. 807,P=0. 000); PFDI-20评分术前(60. 5±3. 1)分,明显高于术后(11. 7±1. 1)分(t=94. 586,P=0. 000); PSIQ-12评分由术前(61. 2±9. 3)分提高为术后末次随访(70. 0±8. 3)分(t=-5. 588,P=0. 000)。术后患者主观满意度92. 5%(37/40)。结论腹腔镜下髂耻韧带固定术是治疗以子宫脱垂为主的POP微创、简单、安全、有效的方法。

Objective To evaluate the clinical effectiveness of laparoscopic pectopexy for pelvic organ prolapse (POP).Methods From November 2014 to September 2016,40 patients with POP (POP-Q≥Ⅱ) underwent laparoscopic pectopexy in our hospital.The pelvic organ prolapse quantification (POP-Q) scores,pelvic floor impact questionnaire-short form 7 (PFIQ-7),pelvic floor distress inventory short form 20 (PFDI-20),and POP/urinary incontinence sexual questionnaire 12 (PISQ-12) were undertaken to evaluated the anatomic and functional recovery of surgery. Results The operations were successfully completed in the 40 patients.No injuries of rectum,urethra,bladder,great vessels and nerves occurred.After the operation,the catheter was retained for 1-2 days,and all of the patients were able to micturate after extubation.The follow-up time was (20.3±6.2) months.No mesh erosion or exposure occurred.According to the POP-Q,all the cases were cured without recurrence within 3 months of follow-up.The anatomic cure rate of the surgery was 100%.Anterior defect cystocele relapsed in two patients at 12 and 18 months postoperatively.The scores of PFIQ-7 were recovered from (67.7±1.9) points preoperatively to (12.2±1.4) points postoperatively (t=172.807,P=0.000).The PFDI-20 scores were recovered from (60.5±3.1) points to (11.7±1.1) points (t=94.586,P=0.000).The PISQ-12 scores increased from (61.2±9.3) points to (70.0±8.3) points (t=-5.588,P=0.000).The postoperative satisfaction rate was 92.5%(37/40). Conclusion Laparoscopic pectopexy offers a microinvasive,safe,and effective alternative for POP.