改良盆底重建术和腹腔镜下阴道骶骨固定术治疗Ⅲ度~Ⅳ度盆腔器官脱垂的双盲随机研究

Modified double-blind randomized study of modified pelvic floor reconstruction and laparoscopic vaginal iliac fixation for Ⅲ~Ⅳ pelvic organ prolapsed

目的探究改良盆底重建术与腹腔镜更下阴道骶骨固定术治疗重度(Ⅲ度~Ⅳ度)盆腔器官脱垂的临床价值。方法选取安徽医科大学附属妇幼保健院(安徽省妇幼保健院)2015年1月至2018年10月诊治的86例Ⅲ度~Ⅳ度盆腔器官脱垂患者作为研究对象。依据手术方式不同分为两组,观察组(58例)采用经阴道改良盆底重建术(协和术式)治疗,对照组(28例)采用腹腔镜下阴道骶骨固定术。于手术前后分别使用盆腔器官脱垂定量分度法(POP-Q)、盆底功能障碍疾病相关问卷-简要版(PFDI-20)、盆底器官脱垂/尿失禁对性功能影响影响调查问卷(PISQ-12)以及国际尿失禁调查问卷(ICIQ-SF)对手术效果进行评估;比较两组患者手术情况以及并发症发生率情况。结果术后两组患者POP-Q各指示点解剖位置均明显改善,观察组Aa、Ba、C、Ap、Bp点恢复效果优于对照组,差异具有统计学意义(P<0.05);术前两组患者PFDI-20、PISQ-12和ICIQ-SF评分差异无统计学意义(P>0.05),术后观察组PFDI-20、ICIQ-SF评分降幅均优于对照组,PISQ-12评分增幅低于对照组,差异具有统计学意义(P<0.05);观察组手术用时短于对照组,对照组术中出血量、术后住院时间由于观察组,差异具有统计学意义(P<0.05);术后观察组并发症发生率为13.79%,对照组为17.86%,差异无统计学意义(P>0.05)。结论改良盆底重建术术式治疗Ⅲ度~Ⅳ度盆腔器官脱垂更好的修复盆底功能,缓解患者症状表现,安全性满足要求,但患者术后性生活质量略差。

Objective To investigate the clinical value of modified pelvic floor reconstruction and laparoscopic vaginal iliac bone fixation for severe(Ⅲ~Ⅳ) pelvic organ prolapse. Methods 86 patients with Ⅲ~Ⅳ pelvic organ prolapse from January 2015 to October 2018 were selected as experimental subjects. They were divided into two groups according to different surgical methods. The control group(28 cases) used abdominal cavity. Under the microscope, vaginal iliac bone fixation was performed. The observation group(58 cases) was treated with transvaginal modified pelvic floor reconstruction(Concord). Questionnaire on the influence of pelvic organ prolapse quantitative indexing(POP-Q), pelvic floor dysfunction disease-related questionnaire(PFDI-20), pelvic floor prolapse/urinary incontinence on sexual function before and after surgery(PISQ-12) and the International Urinary Incontinence Questionnaire(ICIQ-SF) were used to evaluate the surgical outcome;the surgical status and complication rate were compared between the two groups. Results The anatomical locations of POP-Q indication points were significantly improved in the two groups. The recovery of Aa, Ba, C, Ap and Bp points in the observation group was better than that in the control group(P<0.05). There was no significant difference in PISQ-12 and ICIQ-SF scores(P>0.05). The decrease of PFDI-20 ICIQ-SF score in the postoperative observation group was better than that in the control group, and the PISQ-12 score was lower than that in the control group(P<0.05);The observation group was shorter than the control group, the control group had intraoperative blood loss and postoperative hospital stay due to the observation group(P<0.05);the postoperative observation group had a complication rate of 13.79%, and the control group was 17.86%(P>0.05). Conclusions Modified pelvic floor reconstruction for the treatment of Ⅲ~Ⅳ pelvic organ prolapse better repair pelvic floor function, relieve the patient's symptoms and safety, meet the requirements, but the patient's postoperative quality of life is slightly worse.