新型盆底穿刺引导器在中盆腔脱垂治疗中的应用及随访研究

Application and follow-up of a new pelvic floor puncture guide in middle pelvic organ prolapse

目的评价新型盆底穿刺引导器在中盆腔脱垂骶棘韧带固定术中应用的临床疗效。方法选择2018年1月至2020年12月在苏州大学附属第一医院收治的105例重度子宫脱垂患者为研究对象,将其分为3组,利用新型盆底吻合器行阴式全子宫切除术+阴道前壁修补术联合骶棘韧带固定术(TVH+AC+SSLF1组)的患者35例,行阴式全子宫切除术+阴道前壁修补术联合传统骶棘韧带固定术(TVH+AC+SSLF2组)的患者35例,行阴式全子宫切除+阴道前后壁修补术(TVH+AC+PC组)患者35例,对比分析3组的手术时间、术前术后血红蛋白差值、术后留置导尿管时间、术后首次排气时间、住院时间,术后盆底功能障碍问卷(PFIQ-7、PFDI-20)及性生活质量PISQ-12评分。结果所有患者手术均顺利完成,3组术后留置导尿管时间、术后首次排气时间及住院时间差异均无统计学意义(P>0.05),但TVH+AC+SSLF1组和TVH+AC+PC组的手术时间明显小于行TVH+AC+SSLF2组(P<0.05),并且术前术后血红蛋白差值均明显低于TVH+AC+SSLF2组。治疗后3组的术后盆底功能PFIQ-7、PFDI-20问卷在术后6个月、术后1年均较术前有明显改善(P<0.05),TVH+AC+SSLF1组与TVH+AC+SSLF2组的性生活PISQ-12评分在术后6个月、术后1年较术前有明显改善,而TVH+AC+PC组的性生活PISQ-12评分在术后6个月较术前无明显改善(P>0.05),术后1年有改善(P<0.05)。3组术后1年脱垂复发率比较差异无统计学意义(P>0.05)。结论利用新型盆底穿刺引导器施行阴式全子宫切除术+阴道前壁修补术联合骶棘韧带固定术成为一种安全、快捷、有效且容易学习的手术方式。

Objective To evaluate the clinical curative effects of novel pelvic floor puncture guide in operation of sacrospinous ligament fixation for middle pelvic organ prolapse.Methods A total of 105 patients with severe uterine prolapse admitted to tthe First Affiliated Hospital of Soochow University from January 2018 to December 2020 were selected as the research subjects,and they were divided into three groups:35 cases underwent vaginal hysterectomy,anterior colporrhaphy and sacrospinous ligament fixation by using the novel pelvic floor puncture guide(TVH+AC+SSLF1);35 cases underwent vaginal hysterectomy,anterior colporrhaphy and sacrospinous ligament fixation without the novel pelvic floor puncture guide(TVH+AC+SSLF2)and the rest 35 cases received vaginal hysterectomy and anterior and posterior colporrhaphy(TVH+AC+PC).The following items were compared and analyzed:the operation time,preoperative and postoperative hemoglobin difference,postoperative indwelling catheter time,postoperative first flatus time,hospital stay,postoperative pelvic floor dysfunction questionnaire(PFIQ-7,PFDI-20)and sexual life quality PISQ-12 score.Results All patients were successfully operated.Statistically,there was no difference among the three groups in terms of postoperative indwelling catheter time,postoperative first flatus time or hospital stay(P>0.05).However,the operation time of TVH+AC+SSLF1 group and TVH+AC+PC group was significantly shorter than that of TVH+AC+SSLF2 group(P<0.05),and the difference in preoperative and postoperative hemoglobin was significantly lower than that of TVH+AC+SSLF2 group.As shown in PFIQ-7 and PFDI-20 questionnaires,the postoperative pelvic floor function of the three groups was significantly improved than before in six months and one year after operation(P<0.05).The first two groups'PISQ-12 scores were improved obviously compared with the preoperative in six months and one year after treatment.However,there was no substantial improvement in the third group's PISQ-12 score in six months after treatment(P>0.05);nevertheless,an improvement existed in one year after treatment(P<0.05).There were statistically obvious differences in the recurrence rate of prolapse within one year after operation among all the three groups.Conclusion The use of the novel pelvic floor puncture guide makes vaginal hysterectomy,anterior colporrhaphy and sacrospinous ligament fixation(TVH+AC+SSLF)be a safe,fast,effective and easy-to-learn operation method.