腹腔镜子宫悬吊术与传统阴式子宫切除术均联合阴道前后壁修补治疗盆腔器官脱垂的疗效比较

Efficacy of Laparoscopic Ventrifixation and Traditional Vaginal Hysterectomy Respectively Combined with Anterior and Posterior Vaginal Wall Repair in the Treatment of Pelvic Organ Prolapse: a Comparative Study

目的:比较腹腔镜子宫悬吊术与传统阴式子宫切除术均联合阴道前后壁修补治疗盆腔器官脱垂(POP)的疗效。方法:选择2017年1月至2019年9月本院收治的POP患者96例为研究对象,国际尿控协会POP量化分期(POP-Q)为Ⅱ~Ⅳ期,采用随机数字表法将其分为观察组(49例)采用腹腔镜子宫悬吊术联合阴道前后壁修补术,对照组(47例)采用传统阴式子宫切除联合阴道前后壁修补术,对比两组手术相关指标及手术前后盆底不适调查表短表20评分(PFDI-20),及其分量表(POPDI-6)、肠道脱垂分量表(CARDI-8)、排尿有关症状分量表(UDI-6)和盆底功能解剖学参数Aa、Ba、C、Ap、Bp、TVL变化,以女性性功能评分量表(FSFI)、性生活质量问卷(PISQ)评估其性生活质量,记录两组并发症及随访1年治愈率、复发率。结果:观察组手术时间、住院时间少于对照组,而术中出血量低于对照组,观察组术后阴道长度较对照组长,差异有统计学意义(P<0.05),两组导尿时间比较差异无统计学意义(P>0.05);观察组术后6个月PFDI-20总评分及POPDI-6、CARDI-8、UDI-6评分均低于对照组,差异有统计学意义(P<0.05);术后6个月两组盆底功能解剖学参数均明显改善,且观察组术后Aa、Ba、C、Ap、Bp、TVL均小于对照组,差异有统计学意义(P<0.05);观察组术后6个月FSFI、PISQ评分高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率(4.08%)低于对照组(17.02%),差异有统计学意义(P<0.05);观察组1年治愈率高于对照组(95.92%vs 82.98%),而复发率低于对照组(2.13%vs 20.51%),差异有统计学意义(P<0.05)。结论:与传统阴式子宫切除联合阴道前后壁修补术相比,腹腔镜子宫悬吊术联合阴道前后壁修补术治疗POP有更好的效果,不仅改善手术时间、住院时间、术中出血量,促进术后恢复,增加阴道长度,也可明显改善盆底功能及解剖学参数,提高性生活质量,且并发症发生率低,远期效果好,值得在临床推广实践。

Objective:The aim of this study was to compare the therapeutic effects between laparoscopic ventrifixation and traditional vaginal hysterectomy respectively combined with anterior and posterior vaginal wall repair in the treatment of pelvic organ prolapse(POP).Methods:96 patients with POP of the Pelvic Organ Prolapse Quantification(POP-Q)stage Ⅱ-Ⅳ were included from January 2017 to September 2019.Using random number table method, patients were divided into observation group(n=49,laparoscopic ventrifixation combined with anterior and posterior vaginal wall repair)and control group(n=47,traditional vaginal hysterectomy combined with anterior and posterior vaginal wall repair).Operation-related indicators, changes of the Pelvic Floor Distress Inventory, Short Form 20(PFDI-20)scores and Pelvic Organ Prolapse Distress Inventory 6(POPDI-6),intestinal prolapse(CARDI-8)and Urogenital Distress Inventory(UDI-6)and pelvic floor functional anatomy parameters(Aa, Ba, C,Ap, Bp, TVL)were comparatively analyzed.The Female Sexual Function Index(FSFI)and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ)were used to assess the quality of sexual life.Complications, cure rate and recurrence rate during 1-year follow-up were recorded.Results:Shorter operation time and hospital stay, less intraoperative blood loss, and longer postoperative vaginal length was found in the observation group than in the control group(P<0.05).No difference was observedin catheterization time between 2 groups(P>0.05).The total score of PFDI-20 and scores of POPDI-6,CARDI-8 and UDI-6 of the observation group at 6 months after operation were lower than those in the control group(P<0.05).Pelvic floor functional anatomy parameters of the 2 groups were significantly improved at 6 months after operation.Besides, Aa, Ba, C,Ap, Bp and TVL in the observation group were lower than those in the control group(P<0.05).The observation group had higher FSFI and PISQ scores at 6 months after operation than the control group(P<0.05).The incidence of complications in the observation group was 4.08%,much lower than 17.02% in the control group(P<0.05).The 1-year cure rate of the observation group was higher(95.92% vs. 82.98%),and the recurrence rate was lowercompared with controls(2.13% vs. 20.51%)(P<0.05).Conclusions:Compared with traditional vaginal hysterectomy combined with anterior and posterior vaginal wall repair, laparoscopic ventrifixation combined with anterior and posterior vaginal wall repair is more effective in the treatment of POP.It not only improves operation time, length of hospital stay and intraoperative blood loss, promotes postoperative recovery and increases vaginal length but also significantly improves pelvic floor functional and anatomical parameters as well as quality of sexual life, with a low incidence of complications and good long-term effect.