腹腔镜下髂耻韧带固定术中切除子宫与保留子宫治疗中盆腔器官脱垂的疗效比较

Comparison of the effectiveness of different uterine treatments combined with laparoscopic pectopexy for middle pelvic organ prolapse

目的比较腹腔镜下髂耻韧带固定术中切除子宫与保留子宫治疗中盆腔器官脱垂(POP)的临床疗效及并发症。方法回顾性分析2018年1月至2020年7月于郑州大学第三附属医院收治的96例因中盆腔POP-Q≥Ⅱ度行腹腔镜下髂耻韧带固定术患者的临床资料,其中术中保留子宫者(保留子宫组)23例;同时行阴式全子宫切除者(阴式切除组)39例;同时行腹腔镜下全子宫切除者(腹腔镜切除组)34例,比较三种术式的手术相关指标、术后并发症、术后解剖复位及术后生活质量、性功能改善情况。结果①保留子宫组与阴式切除组、腹腔镜切除组手术时间分别为(103.57±21.02)min、(143.95±17.48)min和145 min(135 min,161.5 min),三组比较,差异有统计学意义(P<0.05);术中出血量分别为20 mL(15 mL,30 mL)、50 mL(30 mL,80 mL)和50 mL(20 mL,50 mL),三组比较,差异有统计学意义(P<0.05)。②术后12个月保留子宫组网片暴露率明显低于另外两组[0 vs 4%(10.26%),1%(2.94%)],三组比较,差异有统计学意义(P<0.05)。③三组术前与术后12个月C点相比均在术后有明显改善(P<0.05)。④三组术后盆底功能障碍性疾病症状问卷-20(PFDI-20)评分、盆底功能影响问卷简表(PFIQ-7)评分较术前均有明显改善(P<0.05);保留子宫组术后12个月女性性功能指数量表(FSFI-6)评分与阴式切除组、腹腔镜切除组[(27.83±1.58)分,24.00(23.00,26.00)分,(25.00±1.68)分]比较,差异有统计学意义(P<0.05)。结论腹腔镜下髂耻韧带固定术可纠正中盆腔器官脱垂、改善患者生活质量,且手术安全性高、术后并发症较少;术中保留子宫者网片暴露率低且性功能改善更为理想,对于有保留子宫意愿的中盆腔器官脱垂患者可考虑行保留子宫的腹腔镜下髂耻韧带固定术。

Objective To compare the clinical efficacy of different uterine treatments combined with laparoscopic pectopexy for middle pelvic organ prolapse(POP).Methods Ninety-six patients who underwent laparoscopic pectopexy due to POP-Q≥Ⅱ medium-pelvic organ prolapse in the Third Affiliated Hospital of Zhengzhou University from January 2018 to July 2020 were collected and divided into three groups according to the treatment regimen:23 patients with uterus retention during the operation(uterus retention group);39 patients with vaginal total hysterectomy during the operation(vaginal hysterectomy group);34 patients with laparoscopic total hysterectomy during the operation(laparoscopic hysterectomy group).Procedure-related indexes,postoperative complications,postoperative anatomical reduction and postoperative improvement of quality of life and sexual function of the three surgical methods were compared.Results①The operation time of uterus retention group,vaginal hysterectomy group and laparoscopic hysterectomy group were[(103.57±21.02)min,(143.95±17.48)min vs 145 min(135 min,161.5 min)](P<0.05),respectively,the intraoperative bleeding volume were[20 mL(15 mL,30 mL),50 mL(30 mL,80 mL),50 mL(20 mL,50 mL)](P<0.05),the difference were statistically significant.②The exposure rate of mesh after 12 months surgery in uterus retention group was significantly lower than another two groups,the difference was significant[0 vs 4%(10.26%),1%(2.94%)](P<0.05).③Compared with pre-operation,the C points among the three groups were significantly improved after 12 months surgery(P<0.05).④Compared with preoperative scores,the three groups of postoperative Pelvic Floor Distress Inventoryshort form 20(PFDI-20)scores,Pelvic Floor Impact Questionnaire-7(PFIQ-7)scores were significantly improved(P<0.05).The Female Sexual Function Index-table 6(FSFI-6)scores after 12 months surgery in uterus retention group was higher than that in another two groups and the difference was statistically significant[(27.83±1.58),24.00(23.00,26.00),(25.00±1.68)](P<0.05).Conclusions Laparoscopic pectopexy can correct middle POP defects,and improve quality of life,with high surgical safety and fewer postoperative complications.Uterine retention during operation has low mesh exposure rate and sexual function improvement is more ideal.Patients for middle POP who want to retention uterus can consider the laparoscopic pectopexy with uterine retention.