不同手术方式治疗生育期子宫脱垂患者的效果分析

Analysis of the effect of different surgical methods in the treatment of uterine prolapse in the reproductive period

目的探讨腹腔镜下高位宫骶韧带悬吊术(laparoscopic high uterosacral ligament suspension,LHUS)联合宫颈截除术与经阴道骶棘韧带固定术(vaginal sacrospinous ligament fixation,SSLF)治疗生育期子宫脱垂的临床效果。方法选择冀中能源峰峰集团有限公司总医院妇科2011年10月至2016年12月收治的78例Ⅱ度以上子宫脱垂患者的临床资料进行回顾性分析,根据手术方法的不同,将患者分为LHUS组(40例)和SSLF组(38例)。采用独立样本t检验比较两组患者手术时间、术中出血量及住院时间。术前及术后6个月采用盆腔器官脱垂生活质量问卷(prolapse quality of life questionnaire,P-QOL)、盆腔脏器脱垂/尿失禁性功能量表(pelvic organ prolapse/incontinence sexual function questionnaire-12,PISQ-12)、盆底功能障碍问卷简要版-20(pelvic floor distress inventory-short form 20,PFDI-20)及盆底功能影响问卷简表(pelvic floor impact questionnaire-short 7,PFIQ-7)对患者生活质量、性功能及盆底功能进行评价,采用配对t检验比较同组术前及术后6个月上述评分。结果两组患者手术时间、术中出血量及住院时间比较,差异均无统计学意义(t值分别为1.593、1.203、0.535,P均>0.05)。LHUS组患者术前P-QOL、PISQ-12、PFDI-20、PFIQ-7评分分别为(55.4±11.1)、(25.1±4.6)、(15.0±4.9)、(8.9±2.8)分,SSLF组分别为(53.7±10.5)、(23.9±3.7)、(14.1±4.2)、(9.2±3.0)分,两组患者术前各指标比较差异均无统计学意义(t值分别为0.694、1.265、0.869、0.457,P均>0.05)。与术前比较,手术后6个月LHUS组患者P-QOL、PISQ-12评分[(87.9±12.0)、(39.1±6.1)分]、SSLF组P-QOL、PISQ-12评分[(81.3±11.7)、(35.6±4.0)分]均增高,差异有统计学意义(t值分别为12.574、11.589、10.823、13.236,P均<0.001),且术后6个月LHUS组患者P-QOL评分高于SSLF组,差异有统计学意义(t=2.458,P<0.05);术后6个月LHUS组PFDI-20、PFIQ-7评分[(2.1±0.3)、(1.3±0.2)分]均降低,差异均有统计学意义(t值分别为16.619、17.123,P均<0.001),且术后6个月LHUS组患者PFDI-20、PFIQ-7评分均低于SSLF组[(2.7±0.3)、(1.9±0.2)分],差异有统计学意义(t值分别为10.096、13.073,P均<0.001)。结论LHUS联合宫颈截除术治疗生育期子宫脱垂,可有效改善患者生活质量、性功能、盆底功能,效果优于SSLF,值得临床推广。

Objective To investigate the therapeutic clinical effect of laparoscopic high uterosacral ligament suspension(LHUS)combined with cervical amputation and vaginal sacrospinal ligament fixation(SSLF)in the treatment of prolapse of uterus in childbearing period.Methods From October 2011 to December 2016,the clinical data of 78 patients with uterine prolapse above gradeⅡtreated in Department of Gynecology,Jizhong Energy Fengfeng Group Hospital were retrospectively analyzed.According to different surgical methods,the patients were divided into LHUS group(40 cases)and SSLF group(38 cases).The operation time,intraoperative bleeding volume and hospital stay of the two groups were compared by independent sample t test.Before and 6 months after the operation,the prolapse quality of life questionnaire(P-QOL),pelvic organ prolapse/incontinence sexual function questionnaire-12(PISQ-12)and pelvic floor distress inventory-short form 20(PISQ-20)were used.PFDI-20 and pelvic floor impact questionnaire-short 7(PFIQ-7)were used to evaluate patients'quality of life,sexual function and pelvic floor function.Paired t test was used to compare the above scores before and 6 months after operation in the same group.Results There were no significant differences in operation time,intraoperative bleeding volume and hospital stay between the two groups(t value were 1.593,1.203 and 0.535,,respectively,all P>0.05).The preoperative P-QOL,PISQ-12,PFDI-20,and PFIQ-7 scores of patients in the LHUS group were(55.4±11.1),(25.1±4.6),(15.0±4.9),(8.9±2.8)points,and(53.7±10.5),(23.9±3.7),(14.1±4.2),(9.2±3.0)in the SSLF group.There was no statistically significant difference in the indexes between the two groups before operation(t value were 0.694,1.265,0.869 and 0.457,respectively,all P>0.05).The scores of P-QOL,PISQ-12 at 6 months after operation in LHUS group((87.9±12.0),(39.1±6.1))and SSLF group((81.3±11.7),(35.6±4.0))were significantly higher than those before operation(t value were 12.574,11.589,10.823 and 13.236,respectively,all P<0.001).The scores of P-QOL and PISQ-12 at 6 months after operation in the two groups were higher than those before operation((87.9±12.0),(39.1±6.1)),and the P-QOL score of LHUS group was higher than that of SSLF group 6 months after operation,the difference was statistically significant(t value were 12.574,11.589,10.823 and 13.236,respectively,all P<0.001).At 6 months after operation,PFDI-20 and PFIQ-7 scores in LHUS group((2.1±0.3),(1.3±0.2)points)were significantly lower than before operation(t value were=16.619 and,17.123,all P<0.001).The PFDI-20 and PFIQ-7 scores in LIHUS group were lower than those in SSLF group((2.7±0.3),(1.9±0.2))at 6 months after operation(t values were 10.096 and 13.073,respectively,all P<0.001).Conclusion LHUS combined with cervical resection in the treatment of prolapsed uterine prolapse can effectively improve the quality of life,sexual function,and pelvic floor function.The effect is better than SSLF,which is worthy of clinical promotion.