经会阴实时三维超声评估不同术式治疗前盆腔脱垂疗效

Real-time three-dimensional perineal ultrasound in evaluation on curative effect of different surgical methods in patients with anterior pelvic floor prolapse

目的探讨经会阴实时三维超声定量评价不同手术方式对前盆腔器官脱垂患者疗效的价值。方法根据不同手术方式,将153例前盆腔器官脱垂患者分为腹腔镜改良阴道旁修补术组(A组,n=28)、单纯改良前盆底重建术组(B组,n=49)、改良前盆底重建术+骶棘韧带悬吊术组(C组,n=76),对3组受检者术前及术后1、3、6个月分别进行经会阴实时三维超声检查,测量并比较手术前后膀胱颈距耻骨联合下缘距离(BSD)、肛提肌裂孔面积(ALH)、尿道旋转角(URA)和膀胱颈移动度(BND),比较3组间术后复发率。结果A、B、C组患者术前及术后1、3、6个月BSD、ALH、URA和BND总体差异均有统计学意义(P均<0.001)。A、B、C组中,术后各指标与术前比较差异均有统计学意义(P均<0.008)。术后3个月与6个月比较,A组4个指标差异均有统计学意义(P均<0.008);B组URA、BND差异均有统计学意义(P均<0.008);C组仅BND差异有统计学意义(P=0.005)。术后6个月,C组复发率均低于A、B组(P=0.001、0.034)。结论改良前盆底重建术+骶棘韧带悬吊术是稳定性好、复发率低的手术方式,实时三维超声能够定量评估前盆底手术疗效。

Objective To explore the value of real-time three-dimensional perineal ultrasound in quantitative evaluation on the effect of different surgical procedures in patients with anterior pelvic floor prolapse. Methods Totally 153 anterior pelvic organ prolapse patients were divided into 3 groups according to different surgical procedures, including modified laparoscopic paravaginal repair group(group A, n=28), simple modified anterior pelvic floor reconstruction group(group B, n=49) and modified anterior pelvic floor reconstruction and sacrospinous ligament suspension group(group C, n=76). Transperineal real-time three-dimensional ultrasound examination was performed before and 1, 3 and 6 months after operation respectively. The bladder neck-symphyseal distance(BSD), area of the levator hiatus(ALH), urethra rotation angle(URA) and bladder neck descent(BND) before and after operation were measured and compared, and the postoperative recurrence rates were compared. Results The total changes of BSD, ALH, URA and BND were significantly different before operation, 1, 3 and 6 months after operation(all P<0.001). There were significant differences of all the 4 indexes before and after operation in all 3 groups(all P<0.008). In group A, all 4 indexes had significant differences between 3 and 6 months after operation(all P<0.008). Three months and 6 months after operation, URA and BND had significant differences(both P<0.008) in group B, but only BND had significant differences(P=0.005) in group C. Six months after operation, the recurrence rate in group C was lower than those in group A and group B(P=0.001, 0.034). Conclusion Modified anterior pelvic floor reconstruction and sacrospinous ligament suspension has high stability and low recurrence rate. Real-time three-dimensional ultrasound can quantitatively evaluate the curative effect of anterior pelvic floor surgery.