基于骶棘韧带/尾骨肌复合体的腹腔镜子宫骶韧带加固固定术治疗盆腔器官脱垂的临床观察

Clinical observation of laparoscopic uterine ligament reconstruction based on sacrospinous ligament/tail muscle complex for pelvic organ prolapsed

目的探讨基于骶棘韧带/尾骨肌复合体的腹腔镜子宫韧带加固固定术治疗盆腔器官脱垂(pelvic organ prolapse,POP)的临床价值。方法选择2016年7月至2018年9月成都市郫都区人民医院收治的100例POP患者,按随机数字表法分为对照组与观察组各50例,对照组采用经阴道骶棘韧带固定术(sacrospinous ligament fixation,SSLF),观察组采用以骶棘韧带/尾骨肌复合体为锚定点的腹腔镜子宫骶韧带加固固定术,观察两组手术一般情况(手术时间、术中出血量、术后排气时间、住院时间、手术并发症),手术前后均测定残余尿量、最大尿流率、最大膀胱测压容量,并进行POP定量分期(Pelvic Organ Prolapse Quantitation,POP-Q),采用盆腔障碍性疾病问卷(Pelvic Floor Distress Inventory Short Form 20,PFDI-20)及性功能问卷表(Prolapse and Incontinence Sexual Function Questionnaire-12,PISQ-12)评定盆腔功能及性生活的变化。结果①观察组手术时间长于对照组,手术并发症发生率低于对照组,差异有统计学意义(P<0.05)。②术前,两组残余尿量、最大尿流率、最大膀胱测压容量比较,差异无统计学意义(P>0.05);术后6个月,两组上述指标均改善,且观察组优于对照组,差异有统计学意义(P<0.05)。③术前,两组PFDI-20表各维度评分、PISQ-12表评分比较,差异无统计学意义(P>0.05),术后6个月,两组PFDI-20表各维度评分均降低、PISQ-12表评分上升,观察组PFDI-20表评分低于对照组,PISQ-12表评分高于对照组,差异均有统计学意义(P<0.05)。结论基于骶棘韧带/尾骨肌复合体的腹腔镜子宫韧带加固固定术治疗POP疗效肯定,可改善患者排尿功能、盆腔功能障碍,优化性生活质量,且并发症少,安全性高。

Objective To explore the clinical value of laparoscopic uterine ligament fixation based on sacrospinous ligament/coccygeus complex in the treatment of pelvic organ prolapse(POP).Methods 150 patients with POP who were admitted to Pidu District People’s Hospital from July 2016 to September 2018 were selected and divided into control group and observation group according to the random number table method,with 50 cases in each group.Control group was treated with transvaginal sacrospinous ligament fixation(SSLF),and observation group was treated with laparoscopic uterine ligament fixation with sacrospinous ligament/coccygeus complex as the anchor point.The general conditions of operation(operative time,intraoperative blood loss,postoperative exhaust time,hospital stay,operative complications)were observed in the two groups,and the residual urine volume,maximum urinary flow rate and maximum cystometric capacity were measured before and after operation,and Pelvic Organ Prolapse Quantitation(POP-Q)was performed,and the Pelvic Floor Distress Inventory Short Form(PFDI-20)and Prolapse and Incontinence Sexual Questionnaire-12(PISQ-12)were used to assess changes of pelvic function and sexual life.Results①The operation time of the observation group was longer than that of the control group,the incidence of surgical complications was lower than that of the control group,the difference was statistically significant(P<0.05);②Preoperative,there were no significant difference in residual urine volume,maximum urinary flow rate,and maximum cystometric capacity between the two groups(P>0.05).At 6 months after operation,the above indexes increased in both groups,and the increase in the observation group was higher than that in the control group.The difference was statistically significant(P<0.05);③Before the operation,the scores of the PFDI-20 and the PISQ-12 of the two groups were not statistically different(P>0.05).After 6 months,the scores of all the dimensions of the PFDI-20 table decreased,and the score of PISQ-12 increased in both groups.The score of PFDI-20 in the observation group was lower than that of the control group,and the score of PISQ-12 was higher than that of the control group,the differences were statistically significant(P<0.05).Conclusion Laparoscopic uterine ligament fixation based on sacrospinous ligament/coccygeus complex has definite efficacy in the treatment of POP,and it can improve urinary function and pelvic dysfunction and optimize sexual quality,and it has few complications and high safety.