腹腔镜下髂耻韧带悬吊术与经阴道骶棘韧带悬吊术治疗中盆腔器官脱垂疗效比较

Comparison of therapeutic effects of laparoscopic pectopexy and vaginal sacrospinous ligament fixation in the treatment of middle pelvic organ prolapse

目的比较腹腔镜下髂耻韧带悬吊术(LP)与经阴道骶棘韧带固定术(VSSLF)治疗中盆腔器官脱垂的临床疗效。方法选择2020年9月至2021年9月新乡医学院第一附属医院收治的87例中盆腔器官脱垂患者为研究对象,根据手术方式将患者分为LP组(n=45)和VSSLF组(n=42)。记录并比较2组患者的手术时间、术中出血量、术后留置尿管时间、残余尿量、术后住院时间、住院费用。于术后6个月和术后1 a评估2组患者的临床疗效,并计算治愈率和复发率。根据盆腔脏器脱垂定量(POP-Q)测量指示点Aa、Ba、C、Ap、Bp点位置及阴道总长度(TVL)。术前、术后6个月及术后1 a,采用盆底功能障碍性疾病症状问卷-20(PFDI-20)和盆底器官脱垂影响问卷-7(PFIQ-7)评估2组患者的生活质量。术前及术后1 a,采用盆腔器官脱垂尿失禁性生活问卷-12(PISQ-12)评估2组患者的性生活质量。术后1 a内每个月对患者进行随访,了解患者并发症发生情况。结果2组患者手术时间、术后留置尿管时间、残余尿量及术后住院时间比较差异无统计学意义(P>0.05);LP组患者术中出血量显著低于VSSLF组(P<0.05);LP组患者住院费用显著高于VSSLF组(P<0.05)。术后6个月,VSSLF组与LP组患者的复发率和治愈率比较差异无统计学意义(P>0.05);术后1 a,VSSLF组患者的复发率显著高于LP组,治愈率显著低于LP组(P<0.05)。术前、术后6个月及术后1 a,LP组与VSSLF组患者的Aa、Ba、C、Ap、Bp指示点测量值及TVL比较差异无统计学意义(P>0.05);2组患者术后6个月和术后1 a的Aa、Ba、C、Ap、Bp指示点测量值均显著低于术前(P<0.05);2组患者术后6个月与术后1 a的Aa、Ba、C、Ap、Bp指示点测量值比较差异无统计学意义(P>0.05);2组患者术前、术后6个月及术后1 a的TVL组内两两比较差异均无统计学意义(P>0.05)。术前、术后6个月及术后1 a,LP组与VSSLF组患者的PFDI-20、PFIQ-7评分比较差异无统计学意义(P>0.05);2组患者术后6个月、术后1 a的PFDI-20、PFIQ-7评分均显著低于术前(P<0.05);2组患者术后1 a的PFDI-20、PFIQ-7评分与术后6个月比较差异无统计学意义(P>0.05)。术后1 a,LP组40例和VSSLF组38例患者完成PSIQ-12调查;术前及术后1 a,LP组与VSSLF组患者的PSIQ-12评分比较差异无统计学意义(P>0.05);2组患者术后1 a的PSIQ-12评分均显著高于术前(P<0.05)。术后1 a,LP组和VSSLF组患者的并发症发生率分别为4.4%(2/45)和7.1%(3/42),2组患者的并发症发生率比较差异无统计学意义(χ^(2)=0.661,P>0.05)。结论LP和VSSLF治疗中盆腔器官脱垂均可明显改善患者生活质量,患者术后均能获得良好的解剖复位;且LP具有术中出血量少、复发率低等优势。

Objective To compare the clinical efficacy of laparoscopic pectopexy(LP)and vaginal sacrospinous ligament fixation(VSSLF)in the treatment of middle pelvic organ prolapse.Methods A total of 87 patients with middle pelvic organ prolapse admitted to the First Affiliated Hospital of Xinxiang Medical University from September 2020 to September 2021 were selected as the research objects,and the patients were divided into LP group(n=45)and VSSLF group(n=42)according to the operative method.The operation time,intraoperative blood loss,postoperative indwelling catheter time,residual urine volume,postoperative hospital stay time and hospitalization expense were recorded and compared between the two groups.The clinical efficacy of patients in the two groups was evaluated at 6 months and 1 year after surgery,and the cure rate and recurrence rate were caculated.The location of indication points Aa,Ba,C,Ap,Bp and total vaginal length(TVL)were measured according to the pelvic organ prolapsed quantitation(POP-Q).Before surgery,6 months after surgery and 1 year after surgery,the quality of life of patients in the two groups was evaluated by the pelvic floor distress inventory-short form-20(PFDI-20)and pelvic floor impact questionnaire-7(PFIQ-7).The quality of sexual life of patients in the two groups was evaluated by the pelvic organ prolapse-urinary incontinence sexual qustionnaire-12(PISQ-12)before surgery and 1 year after surgery.The patients were followed up every month within 1 year after surgery to understand the incidence of complications.Results There was no significant difference in operation time,postoperative indwelling catheter time,residual urine volume and postoperative hospital stay time of patients between the two groups(P>0.05);the intraoperative bleeding volume of patients in the LP group was significantly lower than that in the VSSLF group(P<0.05);the hospitalization expense of patients in the LP group was significantly higher than that in the VSSLF group(P<0.05).At 6 months after surgery,there was no significant difference in the recurrence rate and cure rate between the VSSLF group and the LP group(P>0.05);at 1 year after surgery,the recurrence rate of patients in the VSSLF group was significantly higher than that in the LP group,and the cure rate was significantly lower than that in the LP group(P<0.05).There was no significant difference in the measurement values of Aa,Ba,C,Ap,Bp indicator points and TVL between the LP group and the VSSLF group before surgery,6 months after surgery and 1 year after surgery(P>0.05);the measurement values of Aa,Ba,C,Ap,and Bp indicator points of patients in the two groups at 6 months and 1 year after surgery were significantly lower than those before surgery(P<0.05);there was no significant difference in the measurement values of Aa,Ba,C,Ap and Bp indicator points of patients in the two groups between 6 months after surgery and 1 year after surgery(P>0.05);there was no significant difference in pairwise comparisons of TVL of patients in the two groups before surgery,6 months after surgery and 1 year after surgery(P>0.05).There was no significant difference in the PFDI-20 and PFIQ-7 scores of patients between the LP group and the VSSLF group before surgery,6 months after surgery,and 1 year after surgery(P>0.05);the PFDI-20 and PFIQ-7 scores of patients in the two groups at 6 months after surgery and 1 year after surgery were significantly lower than those before surgery(P<0.05);there was no significant difference in the PFDI-20 and PFIQ-7 scores of patients in the two groups between 1 year after surgery and 6 months after surgery(P>0.05).At one year after surgery,40 patients in the LP group and 38 patients in the VSSLF group completed PSIQ-12 surveys;there was no significant difference in PSIQ-12 scores between the LP group and the VSSLF group before surgery and 1 year after surgery(P>0.05);the PSIQ-12 score of patients in the two groups at one year after surgery was significantly higher than that before surgery(P<0.05).The incidence of complications of patients in the LP group and VSSLF group was 4.4%(2/45)and 7.1%(3/42),respectively at one year after surgery.There was no significant difference in the incidence of complications of patients between the two groups(χ^(2)=0.661,P>0.05).Conclusion Both LP and VSSLF can significantly improve the quality of life of patients with middle pelvic organ prolapse,and patients can obtain good anatomical reduction after surgery;and LP has advantages such as low intraoperative bleeding and low recurrence rate.