自裁网片腹腔镜阴道骶骨固定术联合阴道后壁修补术与传统阴式手术治疗盆腔器官脱垂的效果比较

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目的探讨自裁网片腹腔镜阴道骶骨固定术联合阴道后壁修补术与传统阴式手术治疗盆腔器官脱垂的效果比较。方法回顾性选取2019年9月至2021年6月九江市妇幼保健院收治的112 例盆腔器官脱垂患者作为研究对象，按照不同手术方式分为观察组（62 例）与对照组（50 例）。观察组行自裁网片腹腔镜阴道骶骨固定术联合阴道后壁修补术，对照组行传统阴式全子宫切除术联合阴道前后壁修补术。比较两组患者的手术时间、住院时间、术中出血量、术后阴道长度、手术并发症、复发率来评价手术疗效，比较术后1年盆腔器官脱垂定量分期法（POPQ）各位点的定量值来评估两组患者术后盆底功能改善状况，比较术后6 个月盆底功能障碍问卷（PFDI-20）和盆腔器官脱垂/尿失禁性生活问卷（PISQ-12）评分来评估两组患者术后生活质量的改善情况。结果观察组的手术时间长于对照组，差异有统计学意义（P＜0.05）。两组患者的住院时间比较，差异无统计学意义（P＞0.05）。观察组术中出血量少于对照组，观察组术后阴道长度长于对照组，手术并发症及复发率低于对照组，差异均有统计学意义（P＜0.05）。两组患者术后12 个月POP-Q 位点Aa、Ba、Ap、Bp 定量值比较，差异无统计学意义（P＞0.05）。观察组POP-Q 位点C 定量值长于对照组，差异有统计学意义（P＜0.05）。术后6 个月观察组PFDI-20 评分低于对照组，PISQ-12 评分高于对照组，差异均有统计学意义（P＜0.05）。结论与传统阴式全子宫切除术联合阴道前后壁修补术相比较，自裁网片腹腔镜阴道骶骨固定术联合阴道后壁修补术治疗盆腔器官脱垂更安全有效，利于盆底功能的修复及性生活质量的提升，同时降低了复发率。

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关键词 ：腹腔镜, 阴道骶骨固定术, 阴道后壁修补术, 自裁网片

Abstract：

Objective To compare the efficacy of self-cutting mesh laparoscopic vaginal sacral fixation combined with vaginal posterior wall repair and traditional vaginal surgery in the treatment of pelvic organ prolapse. Methods A total of 112 patients with pelvic organ prolapse admitted to Jiujiang Maternal and Child Health Hospital from September 2019 to June 2021 were retrospectively selected as the research objects, and were divided into observation group (62 cases) and control group (50 cases) according to different surgical methods. The observation group underwent self-cutting mesh laparoscopic vaginal sacral fixation combined with vaginal posterior wall repair. The control group received traditional total vaginal hysterectomy combined with vaginal wall repair. Operation time, length of hospital stay, intraoperative blood loss, postoperative vaginal length, surgical complications and recurrence rate were compared between the two groups to evaluate the surgical efficacy, and POP-Q values of each point one year after surgery were compared to evaluate the improvement of postoperative pelvic floor function of the two groups. Pelvic floor dysfunction questionnaire (PFDI-20) and pelvic organ prolapse/urinary incontinence questionnaire (PISQ-12) scores were performed 6 months after surgery to evaluate the improvement of postoperative quality of life in both groups. Results The operation time in the observation group was longer than that in the control group, with statistical significance (P＜0.05). There was no significant difference in the length of hospital stay between the two groups (P＞0.05). The amount of intraoperative blood loss in the observation group was less than that in the control group, the length of postoperative vagina in the observation group was longer than that in the control group, and the rate of surgical complications and recurrence was lower than that in the control group, with statistical significances (P＜0.05). There was no significant difference in the quantitative values of POP-Q sites Aa, Ba, Ap, Bp 12 months after operation between the two groups (P＞0.05). The quantitative value of POP-Q site C in the observation group was longer than that in the control group, and the difference was statistically significant (P＜0.05). Six months after surgery, the PFDI-20 score of the observation group was lower than that of the control group, and the PISQ-12 score of the observation group was higher than that of the control group, with statistical significance (P＜0.05). Conclusion Compared with traditional total vaginal hysterectomy combined with anterior and posterior vaginal wall repair, self-cutting mesh laparoscopic vaginal sacral fixation combined with posterior vaginal wall repair is more safe and effective in the treatment of pelvic organ prolapse, which is beneficial to the repair of pelvic floor function and the improvement of sexual quality, while reducing the recurrence rate.

Key words： Laparoscope Vagino-sacral fixation Vaginal posterior wall repair Self-cutting mesh

基金资助:江西省卫生健康委科技计划项目（202120066）。

引用本文:

黄霁;王卫星;程显. 自裁网片腹腔镜阴道骶骨固定术联合阴道后壁修补术与传统阴式手术治疗盆腔器官脱垂的效果比较[J]. 中国当代医药, 2022, 29(26): 111-115.
HUANG Ji WANG Weixing CHENG Xian. Comparison of the efficacy of self-cutting mesh laparoscopic vaginal sacral fixation combined with vaginal posterior wall repair and traditional vaginal surgery in the treatment of pelvic organ prolapse. 中国当代医药, 2022, 29(26): 111-115.

链接本文:

https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2022/V29/I26/111

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