保留子宫的微创髂耻韧带固定术对盆腔器官脱垂患者生活质量的影响

Effect of Uterus-Preserving Minimally Invasive Iliopubic Ligament Fixation on the Quality of Life of Patients with Pelvic Organ Prolapse

目的分析保留子宫微创髂耻韧带固定术(以下简称“髂耻韧带固定术”)在盆腔器官脱垂(POP)患者中的应用效果。方法选取三门峡市中心医院2018年2月至2021年6月收治的73例POP患者作为研究对象,依照随机数字表法分为两组,对照组(36例)接受保留子宫腹腔镜下阴道骶骨固定术(LSC)治疗,观察组(37例)接受髂耻韧带固定术治疗。比较两组手术及术后指标、并发症、生活质量、复发情况、手术效果[盆腔脏器脱垂定量(POP-Q)]。结果观察组手术时长较对照组短,术中失血量较对照组少(P<0.05);两组并发症发生情况、术后6个月复发率比较,差异无统计学意义(P>0.05);术后1、6个月,两组阴道前壁中线距处女膜3 cm(Aa)、阴道顶端或前穹窿至Aa点间阴道前壁上段的最远点(Ba)、阴道后壁中线距处女膜3 cm(Ap)、阴道顶端/后穹窿至Ap点间阴道后壁上段的最远点(Bp)均优于术前(P<0.05),但组间比较,差异无统计学意义(P>0.05);术后1、6个月,观察组盆腔器官脱垂/尿失禁性生活质量问卷-12(PISQ-12)评分较对照组高(P<0.05);两组盆底功能影响问卷简表(PFIQ-7)评分比较,差异无统计学意义(P>0.05)。结论髂耻韧带固定术能减少术中失血量,缩短手术时长,用于治疗POP不仅不会增加复发风险,还能提高患者生活质量。

Objective To analyze the value of uterus-preserving minimally invasive iliopubic ligament fixation(hereinafter referred to as“iliopubic ligament fixation”)in patients with pelvic organ prolapse(POP).Methods A total of 73 POP patients admitted to Sanmenxia Central Hospital from February 2018 to June 2021 were selected as the research subjects and divided into two groups according to the randomized number table method.The control group(36 patients)was treated with uterus-preserving laparoscopic sacral colpopexy(LSC),and the observation group(37 patients)was treated with iliopubic ligament fixation.The surgical and postoperative indicators,complications,quality of life,recurrence and surgical outcomes[pelvic organ prolapse quantification(POP-Q)]after surgery were compared between the two groups.Results The operation time of the observation group was shorter than that of the control group,and the intraoperative blood loss was less than that of the control group(P<0.05).The difference was not statistically significant between the two groups in terms of complications and recurrence rate at 6 months postoperatively(P>0.05).At 1 month and 6 months postoperatively,the midline of the anterior vaginal wall 3 cm from the hymen(Aa),the farthest point of the upper segment of the anterior vaginal wall between the tip of the vagina or the anterior vault and the point Aa(Ba),and the farthest point of the upper segment of the posterior vaginal wall between the tip of the vagina/posterior vault and the point Ap(Bp)were all better than those before surgery(P<0.05),but there was no statistical difference between the groups(P>0.05).At 1 month and 6 months after surgery,the pelvic organ prolapse/incontinence sexual function questionnaire-12(PISQ-12)score was higher than the control group(P<0.05).The pelvic floor impact questionnaire short form(PFIQ-7)scores difference of the two groups was not statistically significance(P>0.05).Conclusion Iliopubic ligament fixation reduces intraoperative blood loss,shortens the duration of surgery,and is used to treat POP not only without increasing the risk of recurrence,but also to improve the quality of life.