腹腔镜下子宫悬吊术联合经阴道闭孔无张力尿道中段悬吊术治疗盆底功能障碍性疾病的效果及对预后复发的影响

Effect of laparoscopic uterine suspension combined with tension free vaginal tape-obturator technique on pelvic floor dysfunction and its influence on prognosis and recurrence

目的探讨腹腔镜下子宫悬吊术(LUS)联合经阴道闭孔无张力尿道中段悬吊术(TVT)治疗盆底功能障碍性疾病(PFD)的效果及对预后复发的影响。方法抽取2019年5月至2021年4月驻马店市中医院收治的PFD患者68例, 按随机数字表法分为LUS+TVT组与经阴道子宫切除术(TVH)组, 每组34例。LUS+TVT组采用LUS联合TVT治疗, TVH组采用TVH治疗。比较两组围术期情况、盆底障碍功能量表(PFDI-20)评分、性生活质量[盆腔器官脱垂-尿失禁-性生活问卷简表( PISQ-12)评分]、压力性尿失禁(SUI)和盆腔脏器脱垂(POP)复发情况及并发症发生情况。结果与TVH组比较, LUS+TVT组手术时间、术后排气时间、住院天数短, 术中失血量少(P<0.05);术后2、6、12个月, LUS+TVT组PFDI-20评分低于TVH组(P<0.05);术后6、12个月, LUS+TVT组PISQ-12评分高于TVH组(P<0.05)。术后12个月, LUS+TVT组POP复发率为2.94%(1/34), SUI复发率为5.88%(2/34), 均低于TVH组的23.53%(8/34)、44.12%(15/34), P均<0.05。LUS+TVT组并发症发生率(2.94%, 1/34)低于TVH组(23.53%, 8/34), P<0.05。结论 LUS联合TVT治疗PFD效果确切, 可改善患者手术情况和盆底功能, 并发症少, 并能减少复发, 提升其性生活质量。

Objective To investigate the effect of laparoscopic uterine suspension(LUS)combined with tension free vaginal tape-obturator technique(TVT)in the treatment of patients with pelvic floor dysfunction(PFD),and its influence on prognosis and recurrence.Methods Sixty-eight PFD patients treated in Zhumadian Traditional Chinese Medicine Hospital from May 2019 to April 2021 were selected and divided into LUS+TVT group and transvaginal hysterectomy(TVH)group by random number table method,with 34 cases in each group.LUS+TVT group was treated by LUS combined with TVT,while TVH group was treated by TVH.Perioperative situation,pelvic floor distress inventory-short form 20(PFDI-20)score,sexual life level assessed by short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire(PISQ-12)score,recurrence of stress urinary incontinence(SUI),pelvic organ prolapse(POP),and complications were compared between the two groups.Results Compared with the TVH group,the LUS+TVT group had shorter operation time,shorter postoperative exhaust time,shorter hospitalization days and less intraoperative blood loss(P<0.05).The PFDI-20 score of the LUS+TVT group was lower than that of the TVH group 2,6 and 12 months after operation(P<0.05).The PISQ-12 score of the LUS+TVT group was higher than that of the TVH group 6 and 12 months after operation(P<0.05).The recurrence rate of POP and SUI in the LUS+TVT group were 2.94%(1/34)and 5.88%(2/34),which were lower than 23.53%(8/34)and 44.12%(15/34)in the TVH group 12 months after operation(all P<0.05).The incidence of complications in the LUS+TVT group(2.94%,1/34)was lower than that in the TVH group(23.53%,8/34),P<0.05.Conclusions LUS combined with TVT is effective in the treatment of PFD.It can improve the patient’s operation situation and pelvic floor function,reduce complications and recurrence,improve their quality of sexual life.