子宫骶韧带-阴道悬吊预防子宫切除术后盆底功能障碍性疾病的价值探讨

Efficacy of uterosacral ligament-vaginal suspension for preventing postoperative pelvic floor dysfunction induced by total hysterectomy

目的比较仅行腹腔镜子宫切除术患者与同时行腹腔镜子宫切除术及骶韧带-阴道悬吊术患者的术后发生盆底功能障碍(PFD)的状况,以探讨骶韧带-阴道悬吊术预防子宫切除术后PFD的价值。方法选择2017年7月至2018年2月在我院因子宫良性疾病行腹腔镜全子宫切除术的83例患者,根据有无同时行子宫骶韧带-阴道悬吊手术分为对照组41例及悬吊组42例,术后随访9~14个月,应用专科检查、妇科超声、问卷调查方法评估比较两组患者术后发生PFD的情况。结果与对照组相比,悬吊组术后发生下尿路症状(尿频、尿急、压力性尿失禁)的几率均明显下降,差异均有统计学意义(P<0.01),两组患者在术后便秘、阴道脱垂以及首次性生活时间方面的比较差异均无统计学意义(P>0.05)。结论腹腔镜全子宫切除术同时施行子宫骶韧带-阴道悬吊术可以有效减少子宫切除术后PFD尤其下尿路症状的发生。

Objective To explore if Uterosacral ligament-vaginal suspension could prevent postoperative pelvic floor dysfunction(PFD)induced by total hysterectomy,by comparing status of PFD after single laparoscopical total hysterectomy with laparoscopical suspension combined with total hysterectomy. Methods Eighty three patients with benign gynecological diseases under laparoscopic surgeries from July,2017 to February,2018 were enrolled in this study. Among them,42 cases were divided into the suspension group and the reminder into the control group. They were followed up at outpatient department9 to 14 months after operations. Pelvic examination,ultrasound and pelvic floor questionnaire were used to follow up. Results Compared to the control group,symptoms of PFD concentrated in lower urinary tract was reduced in the suspension group,and the differences were significant(P<0.001). There was no difference in the constipation,vaginal prolapse and first sexul time between the two groups(P>0.05). Conclusion Uterosacral ligament-vaginal suspension could reduce the incidence of postoperative PFD induced by laparoscopic total hysterectomy,especislly in the PFD concentrated in lower urinary tract.