机器臂辅助腹腔镜下子宫骶骨固定术对盆腔器官脱垂患者的疗效和安全性

Efficacy and safety of robotic arm assisted laparoscopic hysterosacral fixation in patients with pelvic organ prolapse

目的评估机器臂辅助腹腔镜下子宫骶骨固定术对盆腔器官脱垂(POP)患者的疗效、安全性,以及对下尿路功能的影响.方法本研究回顾性分析了2019年6月至2020年9月就诊于本中心并接受机器臂辅助腹腔镜下子宫骶骨固定术的POP患者的临床资料,并进行探索性研究.结果共6例患者纳入研究,POP定量分期均在Ⅲ期以上.年龄70~82岁,产次1~3次,均为阴道分娩.手术前后所有患者的各项尿动力学参数均未见明显变化,但术前半数患者合并有逼尿肌过度活动,且均在术后消失.此外,同步X线影像显示术后的盆腔器官更为接近正常解剖位置.POP定量分期提升明确,相关量表显著改善.1例患者门诊复查时诉术后过度拉伸时偶尔出现腰背部不适,予以对症支持处理后好转.结论机器臂辅助腹腔镜下子宫骶骨固定术对POP患者的疗效满意,安全性好.术后解剖位置恢复满意,对下尿路功能影响小.

Objective To evaluate the efficacy and safety of robotic arm assisted laparoscopic hysterosacral fixation in patients with pelvic organ prolapse(POP),and its impact on lower urinary tract function.Methods This study retrospectively analyzed the clinical data of POP patients who had undergone robotic arm assisted laparoscopic hysterosacral fixation at our center from June 2019 to October 2020,and conducted exploratory research.Results A total of 6 patients were included in the study»with POP quantitative staging above stage HI.The ages ranged from 70 to 82 years.The number of births each patient had given ranged from 1 to 3,all were via vaginal deliveries.There were no significant changes in urodynamic parameter scores in any patients before and after surgery,but half of the patients had detrusor overactivity before surgery,which all disappeared after surgery.In addition,synchronous X-ray images showed that the postoperative pelvic organs were closer to the normal anatomical position.At the same time,quantitative staging of POP had achieved clear improvement»and related scale scores also significantly improved.One patient complained of occasional lumbar and back discomfort with postoperative over-stretching during outpatient review,which improved after symptomatic treatment.Conclusions robotic arm assisted Laparoscopic hysterosacral fixation is satisfactory in efficacy and safety for POP patients,with good postoperative restoration of the uterus to the anatomical position and has insignificant influence on the function of the lower urinary tract.It is worth further assessment for wide application.