改良子宫骶棘韧带固定术治疗盆腔器官脱垂的临床疗效

Modified sacrospinous ligament fixation in treatment of pelvic organ prolapse

目的研究保留子宫骶棘韧带固定术(sacrospinous ligament fixation,SSLF)与传统阴式子宫切除术治疗盆腔器官脱垂(pelvic organ prolapse,POP)的临床疗效。方法回顾性分析蚌埠医学院第一附属医院2017年1月至2019年12月收治的68例II~IV度POP患者,其中33例采用保留子宫SSLF(观察组),35例采用阴式全子宫切除术(对照组)。对比两组患者术中出血量、手术时间、术后留置尿管及平均住院时间;术后随访6个月,采用盆底功能障碍问卷-20(PFDI-20)和性生活质量问卷-12(PISQ-12)得分评估患者术后恢复的主观满意程度。结果观察组术中失血量(173.94±52.14)ml、术后留置尿管时间(2.72±0.45)d及平均住院时间(7.09±0.63)d,对照组术中失血量(228.86±53.40)ml、术后留置尿管时间(4.54±0.61)d及平均住院时间(9.22±0.81)d,差异有统计学意义(P<0.05);观察组手术时间(99.57±9.50)min,对照组手术时间(101.06±8.64)min,差异无明显统计学意义(P>0.05);两组患者治疗前后PFDI-20、PISQ-12改善是显著的,观察组术后6个月PISQ-12评分高于对照组,差异有统计学意义(P<0.05),两组PFDI-20评分差异无统计学意义(P>0.05)。两种手术方式POP-Q各指示点位置变化差异有统计学意义(P<0.05)。结论保留子宫SSLF与阴式全子宫切除术治疗中重度POP患者均有效果,但保留子宫的SSLF术中出血量少,术后恢复明显优于阴式全子宫切除术,且满足了多数患者要求保留子宫的愿望,改善了POP患者术后性生活质量,术后满意度较高,值得推广。

Objective To study the clinical effect of sacrospinous ligament fixation(SSLF)and traditional vaginal hysterectomy on pelvic organ prolapse(POP).Methods A retrospective analysis was performed on 68 patients with POP of degree II-IV admittedl from Jan.2017 to Dec.2019.Among them,33 patients were treated with SSLF(observation group)and 35 patients were treated with vaginal total hysterectomy(control group).Intraoperative blood loss,operative time,postoperative indwelling catheter and average length of hospital stay were compared between the two groups.The patients were followed up for 6 months,and the scores of pelvic floor dysfunction questionnaire-20(PFDI-20)and sexual quality questionnaire-12(PISQ-12)were used to evaluate the subjective satisfaction degree of postoperative recovery.Results In the observation group,the intraoperative blood loss(173.94±52.14)ml,postoperative indurating catheter time(2.72±0.45)d and average length of hospital stay(7.09±0.63)d were observed.There were statistically significant differences in intraoperative blood loss(228.86±53.40)ml,postoperative induration time(4.54±0.61)d and mean hospital stay(9.22±0.81)d in the control group(P<0.05).There was no significant difference in the operation time between the observation group(99.57±9.50)min and the control group(101.06±8.64)min,(P>0.05).The improvement of PFDI-20 and PISQ-12 in both groups was significant before and after treatment.The PISQ-12 score of the observation group was higher than that of the control group 6 months after surgery,and the difference was statistically significant(P<0.05).There was no significant difference in PFDI-20 score between the two groups(P>0.05).There was statistical significance in the positions of pop-Q indicators in the two surgical methods(P<0.05).Conclusions SSLF with uterus preservation and total vaginal hysterectomy are both effective in treatment of moderate and severe POP.However,SSLF with uterus preservation has less intraoperative blood loss,and the postoperative recovery is significantly better than that with total vaginal hysterectomy.In addition,it satisfies patients’desire to preserve uterus,improves the postoperative sexual life quality,which is worthy of promotion.