腹腔镜下自体筋膜修复术治疗DeLanceyⅠ和Ⅱ水平盆腔脏器脱垂的近期效果

Evaluation of short-term efficacy of laparoscopic autologous fascial repair for pelvic organ prolapse at the first and second level of DeLancey

目的评估改良腹腔镜下自体筋膜修复术治疗DeLancey I和Ⅱ水平盆腔脏器脱垂的有效性和安全性。方法选取2020年5月至2021年5月因DeLancey I和Ⅱ水平盆腔器官脱垂接受腹腔镜下自体筋膜修复术病例共15例,根据女性盆腔“整体理论”,利用自体筋膜的修复重建达到解剖、功能复位,并根据盆腔脏器脱垂量化分度(POP-Q)分度法和患者的主观感受来评价手术效果。结果手术时间平均(136.18±7.73)min,术中出血平均(52.14±22.59)mL,均无术中输血,术后住院时间平均(5.07±0.62)d,术后随访时间平均(9.36±2.15)个月,主观满意度为86.67%(13/15)。15例患者中,1例患者在术后4个月提重物(约10 kg)时导致子宫脱垂复发,余14例患者与术前相比,DeLancey I和Ⅱ水平所有指示点在术后1年内的位置变化均存在统计学意义(P<0.05)。压力性尿失禁、腰骶部下坠不适、腰酸等症状明显改善。15例患者盆底障碍影响简易问卷(PFIQ-7)评分、盆底不适调查表简表(PFDI-20)评分均较术前下降,差异有统计学意义(P<0.05)。结论此次设计的手术主要针对DeLancey I和Ⅱ水平盆腔脏器脱垂的患者,手术的近期疗效稳定,安全性好,无并发症发生,远期疗效有待进一步观察。

Objective To investigate the effectiveness and safety of laparoscopic autologous fascial repair for pelvic organ prolapse(POP)at the first and second level of Delancey.Methods From May 2020 to May 2021,a total of 15 POP patients who received laparoscopic autologous fascial repair at the first and second level of DeLancey were selected.According to the"overall theory"of the female pelvis,anatomical and functional reduction was achieved by autologous fascia repair and reconstruction.Operation results were evaluated by the Pelvic Organ Prolapse Quantification System(POP-Q)and patients’subjective feelings.Results The mean operation time,intraoperative bleeding,postoperative length of stay,postoperative follow-up time and subjective satisfaction were(136.18±7.73)min,(52.14±22.59)mL,(5.07±0.62)d,(9.36±2.15)months,and 86.67%(13/15),respectively.None of the patients received blood transfusions during the operation.Among the 15 patients,1 patient had recurrent uterine prolapse when lifting heavy objects(about 10kg)4 months after surgery.There were significant difference in the position changes of all indicator points at the first and second level of DeLancey in the remaining 14 patients within 1 year after surgery compared with those before surgery(P<0.05).Stress urinary incontinence,lumbosacral drop discomfort,lumbar acid and other symptoms were significantly improved.The scores of the Pelvic Floor Impact Questionnaire-short form 7(PFIQ-7)and the Pelvic Floor Disability Index(PFDI-20)in 15 patients were significantly lower compared with those before surgery(P<0.05).Conclusion Laparoscopic autologous fascial repair is designed for POP patients at the first and second level of DeLancey,showing a stable short-term efficacy,high safety,and no complication.Its long-term outcome needs to be further observed.