U形骶棘韧带固定术治疗盆腔器官脱垂的疗效分析

Efficacy of U-shaped sacrospinous ligament fixation in the treatment of pelvic organ prolapse

目的观察经阴道U形骶棘韧带固定术对Ⅲ~Ⅳ度盆腔器官脱垂(POP)的临床疗效。方法选取2019年1月—2021年8月邵阳学院附属第一医院收治的Ⅲ~Ⅳ度POP患者77例,按照手术方法不同分为网片组(采用网片置入的改良骶棘韧带吊带固定术)和U形固定组(采用经阴道U形骶棘韧带固定术)。比较2组围术期指标及2组术前、术后6个月、术后12个月的POP定量评价系统(POP-Q)各指标评分、盆底障碍影响简易问卷(PFIQ-7)评分、底功能障碍量表(PFDI-20)评分及盆底脏器脱垂/尿失禁性功能问卷(PISQ-12)评分。结果2组患者术前、术后6个月及12个月POP-Q各项指标比较,差异有统计学意义(P<0.05);2组患者术后6个月及12个月PFIQ-7、PFDI-20及PISQ-12评分与术前比较,差异有统计学意义(P<0.05);2组患者术后12个月的PFIQ-7、PFDI-20及PISQ-12评分与术后6个月比较,差异有统计学意义(P<0.05);2组患者各时点的PFIQ-7、PFDI-20及PISQ-12评分比较,差异无统计学意义(P>0.05)。结论2种手术方式均是治疗中重度POP的有效术式。U形骶棘韧带固定术不使用网片,无网片暴露侵蚀的风险,能够降低医疗费用,减少手术并发症的发生,降低复发率。

Objective To observe the clinical efficacy of the transvaginal U-shaped sacrospinous ligament fixation in the treatment of moderate and severe pelvic organ prolapse(POP).Methods A total of 77 patients withⅢtoⅣdegree POP admitted to the First Hospital Affiliated to Shaoyang University from January 2019 to August 2021 were selected.According to different surgical methods,they were divided into mesh group(treated with modified sacrospinous ligament sling fixation with mesh implantation)and U-shaped fixation group(treated with transvaginal U-shaped sacrospinous ligament fixation).The perioperative indexes of the two groups and the scores of POP quantitative index(POP-Q),Pelvic Floor Impact Questionnaire-Short Form 7(PFIQ-7),Pelvic Floor Distress Inventory-Short Form-20(PFDI-20)and Polish Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ-12)scores of the two groups before surgery,6 months and 12 months after surgery were compared.Results There were significant differences in POP-Q indexes between two groups before surgery,6 months and 12 months after surgery(P<0.05).PFIQ-7,PFDI-20 and PISQ-12 scores at 6 and 12 months after surgery showed significant differences compared with those before surgery(P<0.05).There were significant differences in PFIQ-7,PFDI-20 and PISQ-12 scores 12 months after surgery between two groups compared with those of 6 months after surgery(P<0.05).There was no significant between-group difference in PFIQ-7,PFDI-20 and PISQ-12 scores at each time point(P>0.05).Conclusion Both surgeries are effective in the treatment of moderate and severe pelvic organ prolapse.U-shaped fixation of the sacrospinous ligament without the use of mesh and no risk of mesh exposure erosion can reduce medical costs,surgical complications and recurrence.