改良式阴式子宫切除术治疗子宫脱垂的临床效果观察

Clinical efficacy of modified vaginal hysterectomy in the treatment of uterine prolapse

目的探讨改良式阴式子宫切除术治疗子宫脱垂的临床效果。方法选取凤台县人民医院2017年7月至2021年10月收治的子宫脱垂患者60例为研究对象。根据治疗方法不同分成对照组和观察组,每组30例。对照组患者实施传统阴式子宫切除术(阴式子宫切除术+阴道前后壁修补术),观察组患者则采用改良式阴式子宫切除术(阴式子宫切除术+阴道前后壁修补术+自体韧带悬吊术)。观察两组患者的手术指标变化及治疗有效率,并在第3、6、12个月分别对两组患者进行随访,比较阴道穹窿脱垂情况以及生活质量评分。结果观察组患者的引流量、肛门排气时间、下床活动时间以及住院时间分别为(520.13±52.14)mL、(36.47±5.72)h、(32.48±7.12)h、(16.48±2.67)d,均少于、短于对照组,差异均有统计学意义(t=19.35、18.25、17.56、17.35,均P<0.05)。观察组治疗有效率为93.3%(28/30),明显高于对照组的80.0%(24/30),差异有统计学意义(χ^(2)=6.32,P=0.005)。术后3、6、12个月随访,观察组无阴道穹窿脱垂病例,对照组依次出现2、3、7例,观察组显著优于对照组患者(χ^(2)=4.21,P=0.001);观察组患者术后3、6、12个月生活质量评分均高于对照组[(60.71±7.58)分比(50.69±2.89)分、(76.42±3.50)分比(63.31±8.67)分、(81.30±2.64)分比(70.72±6.51)分],差异均有统计学意义(t=7.21、7.10、6.31均P<0.05)。结论采用改良式阴式子宫切除术治疗子宫脱垂效果理想,能有效减少引流量,缩短排气时间及住院时间,提高患者的生活质量,值得临床推广应用。

Objective To investigate the clinical efficacy of modified vaginal hysterectomy in the treatment of uterine prolapse.Methods A total of 60 patients with uterine prolapse who received treatment in Fengtai County People's Hospital from July 2017 to October 2021 were included in this study.They were divided into control and observation groups(n=30/group)according to different treatment methods.The patients in the control group were treated with traditional vaginal hysterectomy(vaginal hysterectomy+vaginal anterior and posterior wall repair).The patients in the observation group were treated with modified vaginal hysterectomy(vaginal hysterectomy+vaginal anterior and posterior wall repair+autologous ligament suspension).The changes in surgical indicators and treatment effectiveness were evaluated between the two groups.All patients were followed up at 3,6,and 12 months.Vaginal fornix prolapse and quality of life score were compared between the two groups.Results The average drainage volume,average anal exhaust time,the average time to get out of bed,and the average length of hospital stay in the observation group were(520.13±52.14)mL,(36.47±5.72)hours,(32.48±7.12)hours,and(16.48±2.67)hours,respectively,which were significantly less or shorter than those in the control group(t=19.35,18.25,17.56,17.35,all P<0.05).The total response rate in the observation group was 93.3%(28/30),which was significantly higher than 80.0%(24/30)in the control group(χ^(2)=6.32,P=0.005).At 3,6,and 12 months after surgery,vaginal fornix prolapse did not occur in any patient in the observation group,but it occurred in two,three,and seven patients in the control group at the corresponding time points.Treatment efficiency was superior in the observation group to that in the control group(χ^(2)=4.21,P=0.001).At 3,6,and 12 months after surgery,quality of life score in the observation group was significantly higher than that in the control group[3 months:(60.71±7.58)points vs.(50.69±2.89)points;6 months:(76.42±3.50)points vs.(63.31±8.67)points;12 months:(81.30±2.64)points vs.(70.72±6.51)points],and the differences were statistically significant(t=7.21,7.10,6.31,all P<0.05).Conclusion The modified vaginal hysterectomy for the treatment of uterine prolapse has an ideal effect.It can effectively reduce the amount of drainage,shorten the exhaust time and the length of hospital stay,improve quality of life,and thereby is worthy of clinical promotion.