腹腔镜后路径与经阴道骶棘韧带固定术治疗中盆腔器官脱垂临床疗效分析

Analysis of clinical efficacy of posterior laparoscopic approach versus transvaginal sacrospinous ligament fixation in the treatment of middle compartment pelvic organ prolapse

目的:比较分析腹腔镜后路径与经阴道骶棘韧带固定术治疗中盆腔器官脱垂的有效性、安全性及简便性。方法:选择2018年6月至2021年6月郑州大学附属郑州中心医院妇科收治的绝经POP患者54例,其中23例行腹腔镜下全子宫切除+双附件切除+SSLF,31例行经阴道全子宫切除+双附件切除+SSLF。分析围术期手术时间、出血量、术后排气时间、术后住院时间、并发症发生率等指标,于术后3、12、24个月对患者进行POP评估,填写PFDI-20、PFIQ-7、PISQ-12问卷并进行并发症情况统计等。结果:腹腔镜后路径与经阴道路径相比,手术时间、术中出血量及围术期并发症发生率差异有统计学意义(P<0.05),残余尿<100mL需留置尿管时间、残余尿、术后排气时间、术后住院时间差异无统计学意义(P>0.05)。两组术后24月的POP-Q各指示点测量值、PFDI-20、PFIQ-7、PISQ-12评估较术前都有明显改善(P<0.05),腹腔镜组术后三项问卷评估均优于经阴道组(P<0.05),但两组术后POP-Q各指示点测量值比较,差异无统计学意义(P>0.05)。术后随访腹腔镜组无复发,经阴道组复发1例,腹腔镜组及经阴道组均有1例漏尿加重,经阴道组另有1例间断臀部疼痛。结论:腹腔镜后路径与经阴道骶棘韧带固定术均是治疗中盆腔脏器脱垂的有效方法,但腹腔镜后路径手术时间更短,操作更简便、出血更少,并发症发生率更低,术后恢复效果更好,值得临床推广。

Objective:To compare and analyze the effectiveness,safety,and simplicity of the posterior laparoscopic approach versus transvaginal sacrospinous ligament fixation in the treatment of middle compartment pelvic organ prolapse.Methods:Fifty-four patients with menopausal pelvic organ prolapse admitted to the Department of Obstetrics and Gynecology at Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2018 to June 2021 were selected.Among them,23 patients underwent laparoscopic panhysterectomy+bilateral adnexectomy+SSLF,and 31 patients underwent transvaginal panhysterectomy+bilateral adnexectomy+SSLF.Perioperative parameters,including operation time,blood loss,time to first flatus,length of hospital stay(PLOS),and incidence of complications were analyzed.Additionally,patients received POP assessments and filled out questionnaires(PFDI-20,PFIQ-7,and PISQ-12),and statistics were made on their complications at 3,12,and 24 months postoperatively.Result:The differences in operation time,intraoperative blood loss,and incidence of perioperative complications between the posterior laparoscopic method and the transvaginal approach were statistically significant(all P<0.05).However,there were no statistically significant differences in indwell urethral catheterization time for residual urine volume<100mL,residual urine volume,postoperative time to first flatus,or PLOS(all P>0.05).At 24 months postoperatively,both groups demonstrated significant improvements in POP-Q measurements,PFDI-20,PFIQ-7,and PISQ-12 compared with preoperative ones(all P<0.05).Postoperative evaluation of PFDI-20,PFIQ-7,and PISQ-12 in the laparoscopic group was superior to that in the transvaginal group(all P<0.05).However,there were no statistically significant differences in all postoperative measurement parameters of POP-Q(all P>0.05).During postoperative follow-up,there was no recurrence in the laparoscopic group,while one case of recurrence was found in the transvaginal group.There was one patient in both the laparoscopic and transvaginal groups who had exacerbated urine leakage,and one patient in the transvaginal group who had intermittent hip discomfort.Conclusions:Both the posterior laparoscopic approach and transvaginal sacrospinous ligament fixation are effective treatment methods for middle compartment pelvic organ prolapse.However,the posterior laparoscopic approach is worthy of clinical promotion due to its shorter operation time,simpler operation,fewer blood losses,lower incidence of complications,and better postoperative recovery effect.