三种不同手术方式对产后子宫脱垂患者术后疼痛及复发情况的影响

Compare the effects of three different surgical methods on postoperative pain and recurrence in patients with postpartum uterine prolapse

目的比较三种不同手术方式对产后子宫脱垂患者术后疼痛及复发的影响。方法选取2018年1月至2019年4月烟台毓璜顶医院收治的132例子宫脱垂患者,按照随机数字表法分为3组,各44例。采用腹腔镜下高位宫骶韧带悬吊术(HUS)治疗者定义为HUS组、采用经阴道骶棘韧带固定术(SSLF)治疗者定义为SSLF组、采用盆底重建术(PFR)治疗定义者为PFR组。比较3组术中一般情况、手术前后生活质量评分、术后疼痛评分、并发症及复发率。结果 HUS组和SSLF组手术时间、自主排尿恢复时间、术后住院时间均显著短于PFR组(P<0.05);术后6个月HUS组和SSLF组的盆底功能障碍性疾病症状问卷量表(PFDI-20)和盆底障碍影响简易问卷7(PFIQ-7)评分均显著低于PFR组(P<0.05),HUS组和SSLF组各评分比较无显著性差异(P>0.05);HUS组和SSLF组不同时间点(术后12、24、36、48 h)的视觉模拟评分法(VAS)评分均显著低于PFR组(P<0.05),HUS组和SSLF组VAS评分无显著性差异(P>0.05);HUS组和SSLF组复发率和HUS组并发症发生率均显著低于PFR组(4.52%vs 4.52%vs 27.23%,22.72%vs 72.72%vs 72.72%,P<0.05),SSLF组并发症及复发率与PFR组无显著性差异(P>0.05)。结论三种不同手术方式对产后子宫脱垂患者治疗效果均有影响,HUS和SSLF疗效相当,在改善盆底、排尿功能、术后疼痛及复发情况方面,显著优于PFR。

Objective To compare the effects of three different surgical methods on postoperative pain and recurrence in patients with postpartum uterine prolapse.Methods From January 2018 to April 2019,132 patients with uterine prolapse in Yantai Yuhuangding Hospital were selected and divided into 3 groups according to the random number table method,with 44 cases in each group.Patients who underwent laparoscopic high uterine suspension(HUS)were defined as the HUS group,those who were treated with suspension sacrospinous ligament fixation(SSLF)were defined as the SSLF group and those treated with pelvic floor reconstruction(PFR).The general conditions,the quality of life scores before and after surgery,the pain scores after surgery,postoperative complications,and recurrence rate were compared between the three groups.Results The operation time,spontaneous urination recovery time,and postoperative hospitalization time of the HUS group and the SSLF group were significantly lower than those of the PFR group(P<0.05).The scores of the Pelvic Floor Dysfunction Symptom Questionnaire(PFDI-20)and the Pelvic Floor Quality of Life Impact Scale(PFIQ-7)scores in the HUS and SSLF groups were significantly lower than those in the PFR group at 6 months after surgery(P<0.05);The visual analogue scoring(VAS)scores of HUS group and SSLF group at different time points(12,24,36,48 hours after surgery)were significantly lower than those of PFR group(P<0.05).There was no significant difference in VAS score between HUS group and SSLF group(P>0.05);The recurrence rate of HUS group and SSLF group and the complication rate of HUS group were significantly lower than those of PFR group(4.52%vs 4.52%vs 27.23%,22.72%vs 72.72%vs 72.72%,P<0.05).The complications and recurrence rates of the SSLF group were not significantly different from those of the PFR group(P>0.05).Conclusion Three different surgical methods have an impact on the treatment of postpartum uterine prolapse patients.HUS and SSLF have comparable effects.They are significantly better than PFR in improving pelvic floor,urination function,postoperative pain and recurrence.