腹腔镜下骶骨固定术治疗围绝经期子宫脱垂的临床研究

Efficacy of laparoscopic sacrocolpopexy in treatment of perimenopausal patients with uterine prolapse

目的观察围绝经期子宫脱垂患者行腹腔镜下骶骨固定术治疗的临床效果。方法选取2015年1月至2019年12月浙江中医药大学附属第二医院和嘉兴市妇幼保健院收治的行腹腔镜下骶骨固定术治疗的围绝经期子宫脱垂患者175例,其中91例行阴道骶骨固定术(切除子宫组),84例行子宫骶骨固定术(保留子宫组)。观察并比较两组患者术中情况,手术前后盆腔器官脱垂定量分期法(POP-Q)各指示点测量值、盆底功能障碍简表(PFDI-20)、女性性功能指数评估(FSFI)评分的变化。结果两组患者术后的POP-Q各指示点测量值均较术前改善(均P<0.05)。两组患者术后PFDI-20评分均较术前明显降低,术后FSFI评分均较术前明显升高,差异均有统计学意义(均P<0.05)。保留子宫组患者手术时间短于切除子宫组、术后FSFI评分高于切除子宫组,差异均有统计学意义(均P<0.05)。两组患者术中出血量、术后POP-Q各指示点测量值及PFDI-20评分比较差异均无统计学意义(均P>0.05)。结论腹腔镜下骶骨固定术创伤小,患者主、客观治愈率高,是一种值得推广的治疗围绝经期女性子宫脱垂的手术方式。

Objective To evaluate the efficacy of laparoscopic sacrocolpopexy(LSC)for perimenopausal patients with uterine prolapse.Methods A total of 175 perimenopausal patients with uterine prolapse who received LSC in the Second Affiliated Hospital of Zhejiang Chinese Medical University and Jiaxing Maternity and Child Health Hospital from January 2015 to December 2019,were enrolled in the study.Among them,91 cases received the hysterectomy at the same time(Group A),and the remaining 84 cases retained the uterus(Group B).The intraoperative conditions,the pelvic organ prolapse quantitation(POP-Q),pelvic floor distress inventory short form 20(PFDI-20),female sexual function index(FSFI)scores before and after the LSC were evaluated and compared between two groups.Results Compared with those preoperatively,the POP-Q scores were significantly improved,the PFDI-20 scores were significantly decreased,and the FSFI scores were significantly increased in both groups after LSC(P<0.05).The operation time of the Group B was significantly shorter than that of Group A,and postoperative FSFI score was significantly higher than that of Group A(P<0.05).There was no significant difference in intraoperative blood loss,postoperative POP-Q and PFDI-20 between the two groups(P>0.05).Conclusion The LSC is effective in treatment of perimenopausal uterine prolapse with less trauma and higher subjective and objective cure rates,which is worth promoting clinically.