全子宫切除术后重建宫颈阴道环对预防盆腔脏器脱垂的临床疗效观察

Observation on the clinical effect of reconstruction of cervix-vaginal ring after total hysterectomy on prevention of pelvic organ prolapse

目的探析全子宫切除术后重建宫颈阴道环对预防盆腔脏器脱垂(pelvic organ prolapse,POP)的临床疗效。方法选取2018年1月至2019年12月于六安市中医院接受子宫全切除术患者100例,根据随机数字表法分为基础组与重建组,各50例。基础组行单纯全子宫切除术治疗,重建组全子宫切除术后行骶主韧带-阴道环重建手术,治疗前后进行盆腔器官脱垂定量分期法(POP-Q)分度,记录两组患者围术期指标,进行12个月随访,统计随访期间患者直肠膨出、膀胱膨出发生情况,比较两组患者生活质量。结果治疗前两组患者Aa、Ba、C、Ap、Bp点测量值比较,差异均无统计学意义(P>0.05),治疗后重建组各点测量值明显高于基础组,差异有统计学意义(P<0.05);两组患者术中失血量、手术时间、住院总时长比较,差异均无统计学意义(P>0.05);治疗12个月后,重建组各维度综合生活质量问卷评分均高于基础组,膀胱膨出及直肠膨出发生率明显低于基础组,差异有统计学意义(P<0.05)。结论全子宫切除术后行宫颈阴道环重建术安全可靠,可预防术后POP发生,有利于提高患者生活质量。

Objective To analyze the clinical effect of reconstruction of the cervix-vaginal ring after total hysterectomy on the prevention of pelvic organ prolapse.Methods A total of 100 patients who underwent total hysterectomy at Lu’an Traditional Chinese Medicine Hospital from January 2018 to December 2019 were selected,and they were divided into basic group and reconstruction group according to a random number table,with 50 cases in each group.The basic group underwent total hysterectomy,and the reconstruction group underwent sacral major ligament-vaginal ring reconstruction after total hysterectomy.POP-Q was performed before and after treatment,and the peripheries of the two groups were recorded.A 12-month follow-up was carried out.During the follow-up period,the incidence of rectocele and cystocele was counted,and the quality of life of the two groups was compared.Results Before treatment,there was no significant difference in the measured values of Aa,Ba,C,Ap,and Bp between the two groups of patients(P>0.05).After treatment,the measured values of each point in the reconstruction group were significantly higher than those in the basic group(P<0.05).There was no statistically significant difference in blood loss,operation time,and total length of hospitalization between the two groups of patients(P>0.05).After 12 months of treatment,the GQOL-74 scores in all dimensions of the reconstruction group were higher than those of the basic group,and the incidence of cystocele and rectocele was significantly lower than that of the basic group,and the difference was statistically significant(P<0.05).Conclusion Cervical vaginal ring reconstruction after total hysterectomy is safe and reliable,can prevent postoperative pelvic organ prolapse and help improve the quality of life of patients.