经阴道子宫切除联合阴道前后壁修补术对盆腔器官脱垂患者生活质量及盆底功能的影响

Effect of transvaginal hysterectomy combined with anterior and posterior vaginal wall repair on quality of life and pelvic floor function in patients with pelvic organ prolapse

目的观察经阴道子宫切除术联合阴道前后壁修补术治疗盆腔器官脱垂(POP)的临床效果及对患者生活质量和盆底功能的影响。方法回顾性分析2013年1月至2017年6月西安交通大学第一附属医院收治的80例行经阴道子宫切除术联合阴道前后壁修补术的POP患者的临床资料,统计所有患者的术中和术后观察指标、临床治疗效果,以及随访术后6个月、12个月、24个月的生活质量[盆底功能障碍问卷-20(PFDI-20)评分、盆底障碍影响简易问卷-7(PFIQ-7)评分、盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)评分]及盆底功能[盆腔器官脱垂定量系统(POPQ)评分]。结果手术均一次成功,成功率为100%。手术时间为(62.44±21.31)min,术中出血量为(135.27±29.55)ml,术中未发生邻近脏器损伤及大出血等并发症。术后排气时间为(23.58±2.19)h,住院时间为(7.21±2.08)d,所有患者伤口甲级愈合;术后6个月的客观治愈率为100%,术后24个月的客观复发率为7.50%;术后6个月的PFDI-20评分、PFIQ-7评分、PISQ-12较术前显著降低(P<0.05),术后12个月的上述3个指标均较术后6个月显著降低(P<0.05),术后12个月的上述3个指标与术后24个月比较,差异无统计学意义(P>0.05);术后6个月盆腔位点Aα、Bα、C、Ap、Bp均较术前改善(P<0.05),术后12个月的盆腔位点Aα、Bα、C、Ap、Bp均较术后6个月显著改善(P<0.05),术前、术后6个月、12个月、24个月的阴道总长度(TVL)差异无统计学意义(P>0.05)。结论经阴道子宫切除术联合阴道前后壁修补术对POP的中远期临床效果良好,并可以有效改善患者的生活质量及盆底功能。

Objective To observe the clinical effect of transvaginal hysterectomy combined with anterior and posterior vaginal wall repair for pelvic organ prolapse(POP)and its impact on quality of life and pelvic floor function.Methods Retrospective analysis of clinical data of 80 patients with POP who underwent transvaginal hysterectomy combined with anterior and posterior vaginal wall repair in the First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to June 2017.All patients were counted for intraoperative procedures.Post-observation indicators,clinical treatment effects,and quality of life at 6,12,and 24 months after follow-up[Pelvic Floor Dysfunction Questionnaire-20(PFDI-20)score,pelvic floor disorder impact questionnaire-7(PFIQ-7)Score,pelvic organ prolapse/urinary incontinence function questionnaire(PISQ-12)score]and pelvic floor function[Pleural Organ Prolapse Quantitative System(POP-Q)score]were recorded and compared.Results The operation was successful once and the success rate was 100%.The operation time was(62.44±21.31)min,and the intraoperative blood loss was(135.27±29.55)ml.There were no complications,such as adjacent organ injury and major bleeding during operation.The postoperative exhaust time was(23.58±2.19)h,and the hospital stay was(7.21±2.08)d.All patients had a grade A wound healing.The objective cure rate was 100%after 6 months.The recurrence rate was 7.50%;the PFDI-20 score,PFIQ-7 score,and PISQ-12 were significantly lower than those of before surgery(P<0.05).The above three indexes at 12 months after surgery were better than those after operation.There was a significant decrease in 6 months(P<0.05).There was no significant difference between the above 3 indexes and 12 months after operation(P>0.05).The pelvic site Aαwas 6 months after operation.Bα,C,Ap,and Bp were all improved compared with preoperation(P<0.05).The pelvic sites Aα,Bα,C,Ap,and Bp were significantly improved at 12 months after operation(P<0.05).There was no significant difference in TVL between preoperative and postoperative 6 months,12 months and 24 months(P>0.05).Conclusion Transvaginal hysterectomy combined with anterior and posterior vaginal wall repair is a good medium-to-long-term clinical effect for POP,and can effectively improve the quality of life and pelvic floor function of patients.