经脐单孔腹腔镜髂耻韧带固定术与阴道骶骨固定术治疗女性盆腔器官脱垂疗效比较

Comparison of the curative effect between transumbilical single-incision laparoscopic pectopexy and single-incision laparoscopic sacrocolpopexy in the treatment of female pelvic organ prolapse

目的比较经脐单孔腹腔镜髂耻韧带固定术(SLP)与经脐单孔腹腔镜阴道骶骨固定术(SLSC)治疗女性盆腔器官脱垂(POP)的临床效果。方法选择2018年8月至2019年7月新乡市中心医院收治的58例女性POP患者为研究对象,根据手术方法将患者分为SLP组(n=30)和SLSC组(n=28);记录2组患者的手术时间、术中出血量、术后尿管留置时间、术后残余尿量、术后并发症及POP复发情况;分别于术前及术后1、6个月对2组患者进行盆腔脏器脱垂定量(POP-Q)测量,包括:Aa(阴道前壁中线距处女膜3 cm处,相当于尿道膀胱沟处)、Ba(阴道顶端或前穹隆到Aa点之间阴道前壁上段的最远点)、Ap(阴道后壁中线距处女膜3 cm处)、Bp(阴道顶端或后穹隆到Ap点之间阴道后壁上段的最远点)、C(宫颈或子宫切除后阴道顶端所处的最远端)和阴道总长度(TVL);术前及术后6个月,采用盆底功能障碍性疾病症状问卷-20(PFDI-20)评估患者的直肠、膀胱功能,采用盆底功能影响问卷简表(PFIQ-7)评估患者的生活质量,采用盆腔脏器脱垂尿失禁性生活问卷-12(PISQ-12)评估患者性功能。结果2组患者术后残余尿量、住院时间比较差异无统计学意义(P>0.05);SLP组患者手术时间显著短于SLSC组,术中出血量显著少于SLSC组(P<0.05)。术前2组患者Aa、Ba、Ap、Bp、C、TVL比较差异均无统计学意义(P>0.05),2组患者术后1、6个月Aa、Ba、Ap、Bp、C显著优于术前(P<0.05),2组患者术后1、6个月与术前TVL比较差异无统计学意义(P>0.05);2组患者术后6个月与术后1个月Aa、Ba、Ap、Bp、C、TVL比较差异无统计学意义(P>0.05);术后1、6个月,2组患者Aa、Ba、Ap、Bp、C、TVL比较差异均无统计学意义(P>0.05)。术前2组患者PFIQ-7、PFDI-20、PISQ-12评分比较差异无统计学意义(P>0.05),2组患者术后6个月PFIQ-7、PFDI-20评分显著低于术前,PISQ-12评分显著高于术前(P<0.05);2组患者术后6个月PFIQ-7、PFDI-20、PISQ-12评分比较差异无统计学意义(P>0.05)。SLSC组和SLP组患者术后并发症发病率分别为10.7%(3/28)、0.0%(0/30),SLP组患者并发症发生率显著低于SLSC组(χ^(2)=0.762,P<0.05)。结论经脐SLP与SLSC治疗女性POP均可获得较好的疗效,但经脐SLP具有手术时间短、术中出血量少及术后并发症发生率低等优势。

Objective To compare the clinical effects of transumbilical single-incision laparoscopic pectopexy(SLP)and single-incision laparoscopic sacrocolpopexy(SLSC)in the treatment of female pelvic organ prolapse(POP).Methods Fifty-eight female patients with POP admitted to Xinxiang Central Hospital from August 2018 to July 2019 were selected as the subjects,and the patients were divided into SLP group(n=30)and SLSC group(n=28)according to the operative method.The operation time,intraoperative bleeding,postoperative catheter indwelling time,postoperative residual urine volume,postoperative complications and recurrence of POP were recorded.The patients were performed with the pelvic organ prolapse quantitative examination(POP-Q)before operation and 1,6 months after operation,including the Aa(the center line of the anterior vaginal wall was 3 cm away from the hymen,which was equivalent to the urethro bladder sulcus),Ba(the farthest point of the upper segment of the anterior wall of the vagina between the top of the vagina or the anterior fornix and the Aa point),Ap(the center line of the posterior vaginal wall was 3 cm away from the hymen),Bp(the farthest point of the upper part of the posterior vaginal wall between the vaginal top or posterior fornix and Ap),C(the farthest end of the vaginal tip after cervix resection or hysterectomy)and the total vaginal length(TVL).Before and 6 months after operation,the rectal and bladder functions of patients were evaluated by the Pelvic Floor Distress Inventory-Short Form 20(PFDI-20),the quality of life of patients was evaluated by the Pelvic Floor Impact Questionnaire-Short Form 7(PFIQ-7),and the sexual function of patients was evaluated by the Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire 12(PISQ-12).Results There was no significant difference in the postoperative residual urine volume and hospitalization time between the two groups(P>0.05).The operation time in the SLP group was significantly shorter than that in the SLSC group,and the intraoperative bleeding in the SLP group was significantly less than that in the SLSC group(P<0.05).There was no significant difference in the Aa,Ba,Ap,Bp,C and TVL between the two groups before operation(P>0.05).The Aa,Ba,Ap,Bp and C at 1 and 6 months after operation were significantly better than those before operation in the two groups(P<0.05).There was no significant difference in the TVL between 1,6 months after operation and before operation(P>0.05).There was no significant difference in the Aa,Ba,Ap,Bp,C and TVL between 6 months and 1 month after operation in the two groups(P>0.05).There was no significant difference in Aa,Ba,Ap,Bp,C and TVL between the two groups at 1 and 6 months after operation(P>0.05).There was no significant difference in the scores of PFIQ-7,PFDI-20 and PISQ-12 between the two groups before operation(P>0.05).The PFIQ-7 and PFDI-20 scores at 6 months after operation were significantly lower than those before operation,and the PISQ-12 score at 6 months after operation was significantly higher than that before operation in the two groups(P<0.05).There was no significant difference in the scores of PFIQ-7,PFDI-20 and PISQ-12 between the two groups at 6 months after operation(P>0.05).The incidence of postoperative complications in the SLSC group and SLP group was 10.7%(3/28)and 0.0%(0/30),respectively.The incidence of complications in the SLP group was significantly lower than that in the SLSC group(χ^(2)=0.762,P<0.05).Conclusion Both transumbilical SLP and SLSC can obtain good curative effects in the treatment of female POP,but the transumbilical SLP has the advantages of short operation time,less intraoperative bleeding and low incidence of postoperative complications.