经阴道自然腔道内镜全子宫切除联合高位骶韧带悬吊术纠正中盆腔缺陷的运用探索

Application of vNOTES-HUS in the treatment of middle pelvic defects

目的 探讨经阴道自然腔道内镜全子宫切除联合高位骶韧带悬吊术(transvaginal natural orifice transluminal endoscopic surgery-high uterosacral ligament suspension, vNOTES-HUS)治疗以中盆腔缺陷为主的盆腔器官脱垂(pelvic organ prolapse, POP)的安全性及有效性。方法 选取2019年1月至2020年6月于福建省妇幼保健院盆底专科行vNOTES-HUS治疗的39例患者为研究组,2018年6月至2020年6月采取腹腔镜全子宫切除联合HUS治疗的52例患者为对照组。通过POP定量分期法(POP quantification stage, POP-Q)、视觉模拟评分法(visual analogue scale, VAS)、盆底障碍影响简易问卷(pelvic floor impact questionnaire short form 7,PFIQ-7)和盆底不适调查表简表(pelvic floor distress inventory short form 20,PFDI 20)比较两组患者手术后疗效及主客观满意度。结果 研究组中3例中转为传统多孔腹腔镜手术,其余患者均顺利完成手术。研究组平均手术时间长于对照组[(167.20±40.55)min vs (130.84±21.20)min],术后24 h VAS评分低于对照组[(1.97±0.65)vs (3.06±0.55)],术后排气时间短于对照组[(24.89±4.17)h vs (28.06±3.36)h],差异均有统计学意义(P<0.05)。术后12个月两组患者PFIQ-7评分及PFDI 20评分均较术前明显降低,差异均有统计学意义(P<0.05),术后两组PFIQ-7评分及PFDI 20评分相比较,差异无统计学意义(P>0.05)。结论 vNOTES-HUS纠正中盆腔缺陷短期随访疗效良好,在减轻术后疼痛、加速术后康复及无瘢痕等方面具有显著优势。

Objective To investigate the safety and efficacy of transvaginal natural orifice transluminal endoscopic surgery-high uterosacral ligament suspension(vNOTES-HUS) in the treatment of pelvic organ prolapse(POP) mainly with middle pelvic defects.Methods A total of 39 patients who underwent vNOTES-HUS in the pelvic floor specialist of Fujian Maternal and Child Health Care Hospital from January 2019 to June 2020 were selected as the research group.From June 2018 to June 2020,52 partients treated by laparoscopic total hysterectomy combined with HUS were the control group.The postoperative curative effect and subjective and objective satisfaction of the two groups were compared with POP quantification stage(POP-Q),visual analogue scale(VAS),pelvic floor impact questionnaire short form 7(PFIQ-7) and pelvic floor distress inventory short form 20(PFDI 20).Results Except for 3 cases in the research group who were converted to traditional multi-hole laparoscopic surgery, the rest of the patients completed the surgery successfully.The average operation time of the research group was longer than that of the control group [(167.20±40.55) min vs(130.84±21.20) min],and the VAS score at 24 hours after surgery was lower than that of the control group [(1.97±0.65) vs(3.06±0.55)],the postoperative exhaust time was shorter than that of the control group [(24.89±4.17)h vs(28.06±3.36)h],and the differences were statistically significant(P<0.05).At 12 months after operation, the PFIQ-7 scores and PFDI 20 scores of the two groups were significantly lower than those before operation, and the above differences were statistically significant(P<0.05).Compared with each other, the difference was not statistically significant(P>0.05).Conclusion The short-term follow-up effect of vNOTES-HUS in correcting mid-pelvic defects is good, and it has significant advantages in reducing postoperative pain, accelerating postoperative recovery, and avoiding scarring.