腹腔镜阴道骶骨固定术中保留子宫与否对女性性功能的影响评价

Evaluation of the Effect of Keeping Uterus or Not on Female Sexual Function in Laparoscopic Vagosacral Fixation

目的对比腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂的疗效及术中是否保留子宫对女性生活质量及性生活满意程度的影响。方法选取2016年1月—2018年1月间在河南省人民医院行腹腔镜阴道骶骨固定术的盆腔器官脱垂≥II期并完成随访的患者149例。分为切除子宫组78例和保留子宫组71例。术前、术后1个月、术后3个月采用妇科检查按照盆腔器官脱垂定量(POP-Q)评分系统进行评分,通过比较术前术后各点数据分析手术的有效性。对两组患者术前、术后1个月、术后3个月、术后6个月和术后12个月分别采用盆底疾病生活质量影响问卷简表(PFIQ-7)和盆腔脏器脱垂-尿失禁性生活问卷(PISQ-12)进行性生活评价。通过评分比较两组患者术后一般生活质量和性生活满意程度。结果术后1月和术后3月POP-Q测量测量结果均显示无盆腔器官脱垂情况,客观治愈率为100%。术后随访12个月均未出现盆腔器官脱垂症状。对两组患者PFIQ-7和PISQ-12评分进行比较,两组患者术后一般生活质量及性生活的满意程度均高于术前(P<0.05),差异有统计学意义。术后6月后保留子宫组的生活质量及性生活的满意程度明显优于切除子宫组(P<0.05),差异有统计学意义。结论腹腔镜下阴道骶骨固定术在治疗盆腔器官脱垂中疗效是确切的,并且能够明显改善患者生活质量及性生活的满意程度,保留子宫对性生活的改善优于切除子宫。

Objective To compare the effect of laparoscopic vagosacral fixation in the treatment of pelvic organ prolapse and the influence of whether the uterus is retained during the operation on the quality of life and sexual satisfaction of women.Methods 149 patients with pelvic organ prolapse≥stage II undergoing laparoscopic vagosacral fixation in Henan People's Hospital from January,2016 to January,2018 were selected and followed up.There were 78 cases in the hysterectomy group and 71 cases in the retention group.Preoperative,postoperative 1 month and postoperative 3 months were scored by gynecological examination according to the quantitative POP-Q scoring system of pelvic organ prolapse.PFIQ-7 and PISQ-12 were used to evaluate the sexual life of the patients in the two groups.The general quality of life and sexual satisfaction were compared between the two groups.Results The results of POP-Q measurement showed that there was no prolapse of pelvic organs in 1 month and 3 months after operation,and the objective cure rate was 100%.All patients were followed up for 12 months without prolapse of pelvic organs.The PFIQ-7 and PISQ-12 scores of the two groups were compared.The general quality of life and satisfaction of sexual life in the two groups were higher than those before operation(P<0.05).The quality of life and satisfaction of sexual life in the group of retaining uterus after 6 months were significantly better than those in the group of removing uterus(P<0.05).Conclusion Laparoscopic vagosacral fixation is effective in the treatment of pelvic organ prolapse,and it can significantly improve the quality of life and satisfaction of sexual life of patients.The improvement of sexual life by retaining the uterus is better than that by removing the uterus.