盆底重建及腹腔镜阴道骶骨固定治疗盆腔脏器脱垂的临床疗效分析

Comparison of pelvic floor reconstruction and laparoscopic sacrocolpopexy for symptomatic pelvic organ prolapse patients

目的:探讨盆底重建与腹腔镜下阴道骶骨固定治疗症状性盆腔脏器脱垂(POP)患者的临床疗效。方法:回顾分析2014年1月～2017年12月因症状性POP于青岛大学附属医院行手术的123例患者,其中71例行盆底重建,52例行腹腔镜阴道骶骨固定。分析患者的术前资料、术中参数、术后并发症及生活质量评分等。结果:盆底重建组患者的手术时间及出血量低于骶骨固定组(P<0.05)。术后3、6、12个月,盆底重建组的客观治愈率分别为100%、97.06%、91.8%,骶骨固定组的客观治愈率分别为98.08%、96.08%、91.3%。两组术后12个月的PFDI-20评分及PFDI-7评分均较术前好转。2例患者发生网片暴露,均为骶骨固定组(2/52,3.85%),两组患者的术后新发尿失禁率无显著差异。盆底重建组术后有21例患者恢复性生活(21/71,29.58%),其中2例出现不同程度的性交痛;骶骨固定组术后有30例患者恢复性生活(30/52,57.7%),无性交疼痛发生。结论:盆底重建与腹腔镜下阴道骶骨固定均能有效改善脱垂患者的临床症状,术前要对患者的基本情况、脱垂程度以及其他因素进行充分评估,选择合理的手术方式。

Objective:To assess the effectiveness and safety of pelvic floor reconstruction and laparoscopic sacrocolpopexy for symptomatic pelvic organ prolapse patients.Methods:123 patients of pelvic organ prolapse underwent surgery were analyzed from Jan.2014 to Dec.2017 in Affiliated Hospital of Qingdao University,71 patients underwent pelvic floor reconstruction,52 patients underwent laparoscopic sacrolcolpopexy.Preoperative data,operation parameters,postoperative complications and the life quality scores were evaluated between the two groups.Result:The mean operation time and mean blood loss were less in the pelvic floor reconstruction group than that in the laparoscopic sacrocolpopexy group(P<0.05).In 123 patients,107 patients were followed-up 12 months completely,there were no significant differences in the cure rates between the two groups.The PFDI-20 score and PFDI-7 score in 12 months after operation were significantly better than preoperation.There only were 2 patients with mesh exposure after operation,occurred in the sacrocolpopexy group(2/52,3.85%).And there were no significant differences in ratio of new onset of urinary incontinence after operation in the two groups.21 patients recovered sex(21/71,29.58%) after operation in the pelvic floor reconstruction group,and 2 cases had different degree of dyspareunia.22 patients recovered sex in sacrocolpopexy group(30/52,57.7%),and no one had dyspareunia.Conclusion:Both methods of operation are effective ways for symptomatic pelvic organ prolapse patients,and significantly improve the quality of patients’ life.And the two methods have their own advantages and disadvantages.therefore,All the preoperative information,such as the pelvic organ prolapse quantitative,sexual demands and so on,should be fully evaluated,then choose the suitable operation for different patients.