腹腔镜腹膜外子宫悬吊联合阴道前壁修补术在前中盆腔脏器脱垂中的临床疗效

Clinical effect of laparoscopic extraperitoneal uterine suspension combined with anterior vaginal wall repair in anterior and middle pelvic organ prolapse

目的 对比分析腹腔镜腹膜外子宫悬吊加阴道前壁修补术与前盆网片植入重建术加骶棘韧带固定术在前中盆腔脏器脱垂(POP)中的安全性及有效性。方法 选取2017年1月~2021年1月因症状性子宫脱垂合并阴道前壁脱垂在威海市妇幼保健院手术的126例患者为研究对象,研究组(n=64)实施腹腔镜腹膜外子宫悬吊加阴道前壁修补术,对照组(n=62)实施前盆网片植入重建术加骶棘韧带固定术,比较两组治疗效果。结果 研究组术中出血量小于对照组,但研究组术后留置尿管时间长于对照组(P <0.05);在手术时间、术中合并手术、以及术后住院时间上,研究组与对照组之间差异无统计学意义(P> 0.05);而对照组术中行计划外手术明显高于研究组(P <0.05)。术后3、6、12个月的客观治愈率,在研究组中分别为98.43%、96.87%、93.75%,在对照组中分别为100%、95.16%、91.93%,两组术后客观治愈率比较差异无统计学意义(P> 0.05)。两组患者的盆底功能障碍问卷(PFDI-20)、盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)评分,在术后12个月较术前均明显改善,而研究组患者术后12个月的PISQ-12评分明显优于对照组(P<0.05)。研究组及对照组术中术后均未出现严重并发症,且均未发生网片暴露事件。结论 两组术式对前中盆腔脏器脱垂患者的治疗均是安全有效的,术前要根据患者的身体状况、脱垂程度、性生活需求以及医生的手术经验选择适合患者的手术方式。

Objective To compare the safety and efficacy of laparoscopic extraperitoneal uterine suspension with anterior vaginal wall repair and anterior pelvic floor reconstruction with sacrospinous ligament fixation for symptomatic anterior and middle pelvic organ prolapsed(POP).Methods A total of 126 patients with symptomatic uterine prolapsed complicated with anterior vaginal wall prolapsed who underwent operation from January 2017 to January 2021 in Weihai Maternal and Child Health Hospital were enrolled in this study.The study group(n = 64) underwent laparoscopic extraperitoneal uterine suspension combined with anterior vaginal wall repair,and the control group(n = 62) underwent anterior pelvic floor reconstruction combined with sacrospinous ligament fixation,and the therapeutic effects of the two groups were compared.Results The mean blood loss in the study group was less than that in the control group,but the mean duration of indwelling catheter after surgery in the study group was longer than that in the control group(P>0.05).There was no statistically significant difference in operation time,intraoperative combined operation and postoperative hospital stay between the study group and the control groups(P<0.05).The number of unplanned operations in control group was higher than in study group(P>0.05).The objective cure rates 3,6 and 12 months after operation were 98.43%,96.87% and 93.75% in the study group and 100.00%,95.16% and 91.93% in the control group,respectively,there was no statistically significant difference in the objective cure rates between the two groups(P<0.05).The PFDI-20 and PISQ-12 scores of the two groups were significantly improved 12 months after operation compared with the preoperative results,and the PISQ-12 score of the study group was higher than that of the control group12 months after surgery(P<0.05).No mesh exposure occurred in two groups,and there was no serious complications in the study group and the control group.Conclusion Both methods of operation are effective ways for sysptomatic anterior and middle pelvic organ prolapsed patients,and significantly improve the quality of patients' life.All the preoperative information,such as patients' basic condition,pelvic prolapse quantitative,sexual demands,doctors' surgical experience and so on,should be fully evaluated,then choose the suitable operation for different patients.