保留子宫的腹腔镜后路骶棘韧带悬吊术治疗中重度中盆腔缺陷的疗效观察

Observation of curative effect of uterine-sparing laparoscopic posterior sacrospinous ligament suspension in the treatment of moderate to severe pelvic defects

目的观察保留子宫的腹腔镜后路骶棘韧带悬吊术(LPASLS)治疗中重度中盆腔缺陷的临床疗效。方法回顾性选取2020年8月至2021年12月同济大学附属第一妇婴保健院妇产科收治的49例中重度中盆腔缺陷患者作为研究对象。依照手术方式不同分为两组,接受保留子宫的经阴道骶棘韧带固定术(SSLF)者为SSLF组(n=23),接受保留子宫的LPASLS者为LPASLS组(n=26)。对比两组患者的围手术期的相关指标、盆腔器官脱垂定量分度(POP-Q)评分、生活质量评分和术后3个月并发症发生情况。结果LPASLS组患者的手术时间、术中出血量和术后住院时间均显著低于SSLF组,术后留置尿管时间明显高于SSLF组,差异均有统计学意义(P<0.05);两组患者术后排气时间比较,差异无统计学意义(P>0.05)。治疗后,LPASLS组患者POP-Q评分中Aa、Ba、C、D、Ap、Bp和TVL测量值显著低于SSLF组,差异均有统计学意义(P<0.05)。两组患者PFIQ-7和PFDI-20评分显著低于治疗前,PISQ-12评分明显高于治疗前,差异均有统计学意义(P<0.05);且治疗后LPASLS组的PISQ-12评分明显高于SSLF组,差异均有统计学意义(P<0.05)。SSLF组复发2例,性交痛1例,网片暴露1例,其他患者恢复较好,无感染、血栓、腹痛等发生;LPASLS组排尿困难1例,性交痛1例,其他患者恢复较好,术后未见并发症,且无复发。结论保留子宫的LPASLS手术,对于治疗中重度中盆腔缺陷疗效显著,与SSLF疗效相当,但保留子宫LPASLS手术的时间明显缩短,出血量少,恢复快,无复发,具有良好的临床应用价值。

Objective To investigate the efficacy of uterine-sparing laparoscopic posterior sacral spine ligament suspension(LPASLS)suspension in the treatment of moderate to severe pelvic defects.Methods A total of 49 patients with moderate and severe pelvic defects treated in Department of Obstetrics and Gynecology,Shanghai First School of Medicine Maternity and Infant Hospital from August 2020 to December 2021 were retrospectively selected as the research object.According to the operation method,they were divided into two groups.The patients who received transvaginal sacral spine ligament fixation(SSLF)with preservation of uterus were SSLF group(n=23),and the patients who received LPASLS with preservation of uterus were LPASLS group(n=26).The perioperative related indexes,pelvic organ prolapse quantitative index(POP-Q)score,quality of life score and complications in 3 months after operation were compared between the two groups.Results The operation time,intraoperative blood loss and postoperative hospital stay in the LPASLS group were significantly lower than those in the SSLF group,and the postoperative indwelling catheter time was significantly higher than that in the SSLF group,the differences were statistically significant(P<0.05).There was no significant difference in time comparison(P>0.05);after treatment,the measured values of AA,Ba,C,D,AP,BP and TVL in POP-Q score in lpasls group were significantly lower than those in SSLF group,the differences were statistically significant(P<0.05).The PFIQ-7 and PFDI-20 scores of the two groups of patients were significantly lower than those before treatment,and the PISQ-12 scores were significantly higher than those before treatment,and the differences were statistically significant(P<0.05);and the PISQ-12 scores of the LPASLS group after treatment were significantly higher than those in the SSLF group,the differences were statistically significant(P<0.05).In the SSLF group,there were 2 cases of recurrence,1 case of dyspareunia,and 1 case of mesh exposure.The other patients recovered well without infection,thrombosis,abdominal pain;dysuria in the LPASLS group 1 case,1 case of dyspareunia,other patients recovered well,no postoperative complications,and no recurrence.Conclusion The uterus-sparing LPASLS has a significant curative effect in the treatment of moderate to severe pelvic defects,which is comparable to the SSLF treatment.However,the uterine-sparing LPASLS has significantly shorter time,less bleeding,faster recovery,and no recurrence,and has good clinical application value.