子宫韧带阴道断端悬吊术预防子宫全切术后盆腔器官脱垂的临床研究

Sacral Ligament Lord-vaginal Ring Reconstruction in the Prevention of Pelvic Organ Prolapse after Hysterectomy

目的探讨行子宫切除术的同时,利用残留的骶、主韧带行多点悬吊术重建阴道环在预防盆腔器官脱垂中的疗效及其对患者术后生活质量的影响。方法选取患有子宫良性病变且排除盆腔器官脱垂患者60例,其中30例行经腹全子宫切除术+骶主韧带阴道环重建术(悬吊组);另30例行单纯经腹子宫全切术(对照组),术前、术后1、3和6个月根据POP-Q分度、阴道长度等指标判断疗效、生活质量问卷(PFID-20)评估患者生活质量。结果悬吊组与对照组患者疾病分布、年龄、产次、术前POP-Q分度、术前PFID-20评分差异均无统计学意义(P>0.05);悬吊组术后1个月Aa点明显高于对照组(P<0.01),术后1、3和6个月,悬吊组的Ap点、Bp点和C点测量值均显著高于对照组(P均<0.05)。而术后3、6个月Aa点、术后1、3和6个月Ba点相两组比较差异均无统计学意义(P均>0.05);生活质量问卷评分术后1个月悬吊组明显低于对照组(P<0.05),术后3、6个月差异无统计学意义(P>0.05)。结论骶主韧带-阴道环重建术可重建阴道环代替宫颈环的盆底支持作用,能够一定程度上预防子宫全切术后盆腔器官脱垂的发生,尤其对于阴道后壁脱垂及穹窿脱垂疗效肯定,副作用少。

Objective To investigate the clinical effect of Sacral ligament lord- vaginal ring reconstruction of life quality for pelvic organ prolapse after the TAH surgery. Methods 60 patients with uterus benign lesion were chosen randomizedly,in which 30 underwent TAH and Sacral ligament lord- vaginal ring reconstruction surgery( suspension group),the other thirty women underwent TAH( control group). POP- Q points and the length of the vaginal were measured for every patient before the surgery,and at postoperative first month,trimester and sixth months to judge the curative effect,and the quality of life questionnaire of the prolift floor( PFDI- 20) were used to investigate the life quality of the patients. Results The POP- Q points and the PFDI- 20 before the surgery had no significant difference in these two groups( P > 0. 05). The POP- Q scores for points Ap,Bp and C of suspension group were significantly further away from the hymen at postoperative first month,trimester and sixth months than those of the control group. The two groups had no significant differences on points Aa and Ba at postoperative first month,trimester and six months. There were significant improvementonsuspensiongroupthanthecontrolgrouponscoresoflifequalityoflife)questionnaireoftheproliftfloor(PFDI-20)atpostoperativefirstmonth,buthadnodifference at trimester and six months. Conclusion Suspension surgery had significantly greater effect in the prevention of pelvic organ prolapse after hysterectomy and obvious benefit for reducing postoperative bladder,intestinal and pelvic symptoms. It is a economic and simple operation and is worth of clinical promotion.