全盆底重建术与经阴道子宫切除+阴道前后壁修补术用于盆腔器官脱垂患者对盆底功能及术后复发的影响

Effect of total pelvic floor reconstruction and transvaginal hysterectomy+anterior and posterior vaginal wall repair on pelvic floor function and postoperative recurrence in patients with pelvic organ prolapse

目的观察经腹腔镜植入Ti LOOP网片(轻型钛化聚丙烯Ti LOOP前盆底修复系统)行全盆底重建术与经阴道子宫切除+阴道前后壁修补术用于盆腔器官脱垂患者对盆底功能及术后复发的影响。方法研究对象为2018年1月至2022年2月在台州市立医院接受治疗的92例盆腔器官脱垂患者,按术式分为对照组(应用传统阴式手术:阴道子宫切除+阴道前后壁修补)43例和研究组(采用经腹腔镜植入Ti LOOP网片行全盆底重建术)49例。比较两组盆腔器官的脱垂分度、手术指标、住院费用、术后复发率及性生活质量、术后远期并发症及生活质量评分。结果术后12个月,研究组脱垂分度为子宫脱垂Ⅱ度及以上的患者占比少于对照组(P<0.05);研究组比对照组术后住院时间短、术中出血量少、导尿时间短,术后残余尿量少(P<0.05),住院费用更高(P<0.05);与对照组相比,研究组术后出现疼痛、尿潴留、阴道出血、膀胱受损以及切口感染并发症的总发生率较低(P<0.05);术后研究组的PFIQ-7得分、PFDI-20得分低于对照组,PISQ-12得分高于对照组(P<0.05);两组患者复发率对比,研究组低于对照组(P<0.05)。结论应用经腹腔镜植入Ti LOOP网片行全盆底重建术治疗盆腔器官脱垂在临床上有较强的实用性,治疗后可有效地控制并发症和复发率,具有一定的安全性,对患者的生活质量有很大的改善。

Objective To observe the effect of total pelvic floor reconstruction with laparoscopic implantation of TiLOOP mesh(light titaniumized polypropylene TiLOOP anterior pelvic floor repair system)and transvaginal hysterectomy(TVH)plus anterior and posterior vaginal wall repair(APR)on pelvic floor function and postoperative recurrence in patients with pelvic organ prolapse(POP).Methods The study subjects were 92 patients with POP who received treatment in Taizhou Municipal Hospital from January 2018 to February 2022,and were divided into control group(traditional vaginal surgery:TVH+APR,43 cases)and study group(laparoscopic implantation of TiLOOP mesh for total pelvic floor reconstruction,49 cases)by means of surgical methods.Pelvic organ prolapse grading,surgical indicators,hospitalization cost,postoperative recurrence rate,sexual life quality,postoperative long-term complications and quality of life scores were compared.Results At 12 months after surgery,the proportions of pelvic organ prolapse gradeⅡand above in study group were less than those in control group(P<0.05).The study group had shorter postoperative hospital stay,less intraoperative blood loss,urinary catheterization time,and less postoperative residual urine volume(P<0.05),and the hospitalization cost was higher(P<0.05).The total incidence rate of complications such as postoperative pain,urinary retention,vaginal bleeding,bladder damage and incision infection was lower in study group compared with that in control group(P<0.05).The scores of PFIQ-7 and PFDI-20 in study group after surgery were lower than those in control group while the score of PISQ-12 was higher than that in control group(P<0.05).The recurrence rate was lower in study group(P<0.05).Conclusion The application of laparoscopic implantation of TiLOOP for total pelvic floor reconstruction has strong clinical practicability in treating POP,and can effectively control complications and recurrence rate after treatment,and it has certain safety and can greatly improve the quality of life of patients.