腹腔镜下脱垂子宫腹壁线型悬吊固定术的临床研究

Clinical study of laparoscopic linear suspension of uterine wall for prolapse

目的研究腹腔镜下脱垂子宫腹壁线型悬吊固定术的临床效果。方法选取8例子宫脱垂患者,根据随机数字表法分为对照组与研究组,每组4例。对照组采用传统阴式子宫切除术治疗,研究组采用腹腔镜下脱垂子宫腹壁线型悬吊固定术治疗。比较两组患者围手术期情况、临床出血指标、疼痛程度、生活质量评分、凝血功能及负面情绪。结果两组患者自主排尿时间、排便时间比较,差异无统计学意义(P>0.05),研究组患者手术时间、下床活动时间均明显短于对照组,差异有统计学意义(P<0.05)。研究组术中出血量、术后3、12 h出血量均少于对照组,差异有统计学意义(P<0.05)。手术前,两组疼痛评分比较,差异无统计学意义(P>0.05);手术后1、6、12个月,研究组疼痛评分低于手术前及对照组,差异具有统计学意义(P<0.05)。手术前,两组生活质量评分比较,差异无统计学意义(P>0.05);手术后,两组生活质量评分高于手术前,且研究组明显高于对照组,差异具有统计学意义(P<0.05)。研究组患者D-二聚体、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)指标均低于对照组,肌钙蛋白I(cTnI)指标高于对照组,差异有统计学意义(P<0.05)。手术前,两组焦虑、抑郁评分比较,差异无统计学意义(P>0.05);手术后,两组焦虑、抑郁评分均低于手术前,且研究组焦虑、抑郁评分(33.27±3.09)、(32.43±3.22)分均明显低于对照组(45.18±3.03)、(50.37±3.46)分,差异具有统计学意义(P<0.05)。结论腹腔镜下脱垂子宫腹壁线型悬吊固定术治疗子宫脱垂效果确切,可保留患者子宫,明显缩短手术时间、下床活动时间,改善凝血指标,减少出血量,提升患者生活质量,值得临床推广与应用。

Objective To study the clinical effect of laparoscopic linear suspension of uterine wall in prolapse.Methods 8 patients with uterine prolapse were selected and divided into control group and study group according to random number table method,with 4 cases in each group.The control group was treated with traditional vaginal hysterectomy,and the study group was treated with laparoscopic linear suspension and fixation of uterine abdominal wall.The perioperative conditions,clinical bleeding indicators,pain degree,quality of life score,coagulation function and negative emotions were compared between the two groups.Results There was no significant diff erence in spontaneous urination time and defecation time between the two groups(P>0.05).The operation time and ambulation time of the study group were significantly shorter than those of the control group,and the diff erences were statistically significant(P<0.05).The amount of blood loss in the study group was less than that in the control group at 3 and 12 h after operation,and the differences were statistically significant(P<0.05).Before operation,there was no significant difference in pain score between the two groups(P>0.05).At 1,6 and 12 months after operation,the pain score of the study group was lower than that before operation and the control group,and the diff erence was statistically significant(P<0.05).Before operation,there was no significant diff erence in the quality of life score between the two groups(P>0.05).After operation,the quality of life score of the two groups was higher than that before operation,and the study group was significantly higher than that of the control group,and the diff erence was statistically significant(P<0.05).The indexes of D-dimer,prothrombin time(PT)and activated partial thromboplastin time(APTT)in the study group were lower than those in the control group,and the indexes of troponin I(cTnI)in the study group were higher than those in the control group,and the diff erences were statistically significant(P<0.05).Before operation,there was no significant diff erence in anxiety and depression scores between the two groups(P>0.05).After surgery,the scores of anxiety and depression in the two groups were lower than those before surgery,and the scores of anxiety and depression in the study group(33.27±3.09)and(32.43±3.22)were significantly lower than those in the control group(45.18±3.03)and(50.37±3.46),and the differences were statistically significant(P<0.05).Conclusion Laparoscopic linear suspension fixation of the abdominal wall of prolapsed uterus is effective in the treatment of uterine prolapse,which can preserve the uterus of patients,significantly shorten the operation time and ambulation time,improve the coagulation index,reduce the amount of blood loss,and improve the quality of life of patients,which is worthy of clinical promotion and application.