老年重度盆腔器官脱垂患者行阴道封闭术是否切除子宫围手术期并发症比较

Comparison of perioperative complications following colpocleisis with and without concomitant vaginal hysterectomy for the treatment of elderly patients with severe pelvic organ prolapse

目的探讨阴道封闭术是否切除子宫治疗老年性重度盆腔器官脱垂(POP)患者的围手术期情况。方法2014年1月至2017年10月采取阴道封闭术治疗老年性POP^Q分期Ⅲ~Ⅳ期POP患者286例,分析阴道封闭术中切除子宫(175例)与未切除子宫(111例)两组的手术时间、术中出血量、手术并发症发生率、术前有排尿困难症状的术后残余尿量情况。结果286例患者的平均年龄为(76.02±5.09)岁(60~90岁),其中220例(76.92%)患者伴有1种以上内科合并症,48例患者同时行抗压力性尿失禁手术。切除子宫组与未切除子宫组的平均手术时间分别为(71.72±21.78)min和(61.69±16.78)min;术中平均出血量分别为(64.86±64.71)ml和(32.97±39.30)ml;平均住院时间分别为(5.97±2.38)d和(5.96±1.70)d,两组比较,差异均有统计学意义(P<0.05)。两组手术并发症发生率[8.57%(15/175)和9.01%(10/111)];两组术后平均拔尿管时间[(3.77±1.61)d和(3.60±1.46)d]、术前排尿困难[(42.86%,75/175)和(48.65%,54/111)]、术后自主排尿后平均残余尿量[(47.48±34.1)ml和(43.17±33.03)ml]比较,差异均无统计学意义(P>0.05)。结论阴道封闭术中切除子宫与不切除子宫患者的围术期并发症、术后自主排尿率相当。内科合并症多、年老体弱、耐受手术能力差的患者,可选择手术时间短、术中出血量少、住院时间短的不切除子宫的阴道封闭术。

Objective To investigate the difference between colpocleisis with and without concomitant vaginal hysterectomy for the treatment of elderly patients with severe pelvic organ prolapse(POP).Methods From January 2014 to October 2017,286 elderly patients with severe POP patients with stage III and IV by POP-Q system underwent colpocleisis.175 patients underwent hysterectomy during colpocleisis and 111 patients were preserved the uterus during colpocleisis.The operative time,intraoperative blood loss,postoperative complications,the mean postvoid residual volumes were analyze in patients who whether or not to remove the uterus during the colpocleisis.Results In 286 patients,the mean age was(76.02±5.09)years old(60〜90 years).Among them,220 patients(76.92%)had more than one medical complication.48 patients underwent anti-urinary incontinence procedure.The mean operative time of the hysterectomy group and the unhysterectomy group was(71.72±21.78)min and(61.69±16.78)min,respectively.The average intraoperative blood loss was(64.86±64.71)ml and(32.97±39.30)ml,respectively.The mean length of stay was(5.97±2.38)d and(5.96±1.70)d,respectively,and the differences were statistically significant(P<0.05).The rate of postoperative complications of patients were 8.57%(15/175)and 9.01%(10/111),the mean duration of postoperative catheter removal of the above two types were(3.77±1.61)and(3.60±1.46)days.Comparison of preoperative dysuria[(42.86%,75/175)and(48.65%,54/111)]and theaverage residual urine volume after voluntary urination[(47.48±34.1)ml and(43.17±33.03)ml]showed no statistical significance(P〉0.05).Conclusions The rate of perioperative complications and spontaneous urination was similar in patients with and without hysterectomy.Patients with multiple medical complications,old age and weak health,and poor tolerance to surgery can choose colpocleisis without hysterectomy with short operation time,less intraoperative blood loss,and short hospital stay.