改良全盆底重建术对盆腔器官脱垂患者围手术期指标、尿动力学及盆底功能的影响

Effects of Modified Reconstruction of Whole Pelvic Floor on Perioperative Indicators,Urodynamics and Pelvic Floor Function of Patients with Pelvic Organ Prolapse

目的改良全盆底重建术治疗对盆腔器官脱垂(POP)患者围手术期指标、尿动力学及盆底功能的影响。方法回顾性分析2016年5月—2019年10月诊治的93例中重度POP患者临床资料,按照治疗方法分为观察组51例和对照组42例,观察组采用Gynemesh聚丙烯补片改良全盆底重建术,对照组采用传统阴式子宫切除术及阴道前后壁修补术治疗。比较2组围手术期指标、并发症,对比治疗前后盆腔肌力、尿动力学、盆底功能障碍情况。结果观察组术中出血量少,手术时间、术后住院时间短,术后残余尿量多(P<0.05)。与术前比较,2组术后盆底肌电位、静态张力、动态张力、收缩力升高,且观察组高于对照组(P<0.05,P<0.01)。与术前比较,术后2组最大尿流率、平均尿流率及膀胱最大容积均有所升高,最大逼尿肌压、最大尿道闭合压有所降低,且观察组较对照组变化显著(P<0.05,P<0.01)。与术前比较,2组术后盆底疾病生活质量影响问卷-7、盆底功能障碍问卷-20评分降低,盆底器官脱垂/尿失禁及性功能调查问卷-12评分升高,且观察组较对照组变化更显著(P<0.05,P<0.01)。观察组术后并发症总发生率低于对照组(P<0.01)。结论改良全盆底重建术治疗POP可显著改善患者尿动力学、盆底功能及整体生活质量,安全性高、术后恢复快。

Objective To analyze effects of modified reconstruction of whole pelvic floor on perioperative indicators,urodynamics and pelvic floor function of patients with pelvic organ prolapse(POP).Methods Clinical data of 93 patients with moderate-severe POP who had been diagnosed and treated between May 2016 and October 2019 was retrospectively analyzed,and the patients were divided into observation group(n=51)and control group(n=42)according to different therapeutic methods.Observation group was treated with modified reconstruction of whole pelvic floor with Gynemesh polypropylene patch,while control group was treated with traditional vaginal hysterectomy and vaginal anterior and posterior wall repair.The perioperative indicators and complications,and conditions of pelvic muscle strength,urodynamics and pelvic floor dysfunction before and after treatment were compared between two groups.Results Compared with those in control group,intraoperative volume of blood loss,operative duration and postoperative hospital stay were less or shorter,while postoperative volume of residual urine output was more in observation group(P<0.05).After operation,values of myoelectric potential,static tension,dynamic tension and contractility of the pelvic floor muscles were significantly higher than those before treatment in two group,and the values in observation group were significantly higher than those in control group(P<0.05,P<0.01).After operation,values of maximum urinary flow rate,average urinary flow rate and maximum bladder volume were significantly increased,while values of maximum detrusor pressure and maximum urethral closure pressure were significantly decreased compared with those before operation in two groups,and the changes in observation group were more significant than those in control group(P<0.05,P<0.01).After operation,scores of pelvic floor impact questionnaire-7(PFIQ-7)and pelvic floor distress inventory-short form 20(PFDI-20)were significantly decreased,while scores of the pelvic organ prolapse/urinary incontinence sexual questionnaire-12(PISQ-12)were significantly increased compared with those before operation,and the changes in observation group were more significant than those in control group(P<0.05,P<0.01).The total incidence rate of complications in observation group was significantly lower than that in control group(P<0.01).Conclusion Modified reconstruction of whole pelvic floor may significantly improve the urodynamics,pelvic floor function and overall quality of life of POP patients.It has good safety and quick recovery after operation.