改良腹腔镜子宫骶骨固定术对中重度子宫脱垂患者的疗效研究

doi:10.13418/j.issn.1001-165x.2021.05.021

摘要/Abstract

摘要： 目的　探讨改良腹腔镜子宫骶骨固定术（MLUC）治疗POP-QⅡ/Ⅲ期中重度子宫脱垂患者的临床疗效及对生活质量的影响。方法　选择我院2017年5月至2019年1月期间收治的中重度子宫脱垂患者60例。采用随机数字法分为常规组和改良组，每组30例。常规组采用常规LUC治疗，改良组采用MLUC治疗。比较两组临床指标、客观治愈率、临床并发症、术后复发率、术后生活质量及性功能改善情况。结果　改良组手术时间、术中出血量、尿管留置时间及住院时间均少于常规组（P<0.001）；术后6个月，两组Aa、Ba、D、Ap、Bp均较术前有显著改善（P<0.001）；常规组术后TVL无明显变化（P>0.05），改良组术后TVL明显少于常规组（P<0.05）；两组客观治愈率比较（改良组93.33%：常规组90.00%），复发率比较（改良组13.33%：常规组16.67%）差异无统计学意义（P>0.05）；改良组临床并发症发生率（6.67%）低于常规组（26.67%），（P<0.05）；术后6个月，两组生活质量及性功能均显著改善（P<0.001），改良组术后PFDI -20、UDI-6、POPDI -6、CRADI-8及性交疼痛评分低于常规组，性欲、性唤起、性高潮、阴道润滑度及性满意度评分高于常规组（P<0.05）。结论　腹腔镜子宫骶骨固定术是中重度子宫脱垂患者安全有效的治疗方法，相较于常规LUC，改良后的LUC操作更简单，术中出血量更少，手术时间及住院时间更短，术后并发症更低，患者生活质量的改善效果更优，值得进一步推广和应用。

关键词: , 改良腹腔镜子宫骶骨固定术；　子宫脱垂；　临床疗效；　并发症；　生活质量

Abstract: Objective　To explore the clinical effect and the effect on the quality of life of patients with pelvic organ prolapse quantitive examination POP-Q Ⅱ/Ⅲmetroptosis treated by modified laparoscopic uterosacral fixation (MLUC).　Methods　Sixty cases of moderate and severe metroptosis admitted in our hospital from May 2017 to January 2019 were selected as the study object. The patients were randomly divided into two groups: a conventional group and an improved group, 30 cases each. The conventional group was treated with laparoscopic uterosacral fixation (LUC), and the improved group was treated with MLUC. The clinical indexes, objective cure rate, clinical complications, recurrence rate, quality of life and sexual function improvement were compared between the two groups.　Results　The operation time, intraoperative bleeding volume, catheter retention time and hospitalization time of the improved group were all less than those of the conventional group (P<0.001). Aa, Ba, D, Ap and Bp of the two groups at six months after operation significantly improved compared with those before operation (P<0.001). There was no obvious change in TVL of the conventional group (P>0.05), but TVL of the improved group was significantly less than that of the conventional group (P<0.05).There was no significant difference in the objective cure rate (93.33% in the improved group: 90.00% in the conventional group), recurrence rate (13.33% in the improved group: 16.67% in the conventional group) between the two groups (P>0.05). The incidence of clinical complications in the improved group (6.67%) was lower than that in the conventional group (26.67%),(P<0.05). Six months after operation, the quality of life and sexual function of the two groups significantly improved (P<0.001). The PFDI -20, UDI-6, POPDI -6, CRADI-8 and the score of sexual pain in the improved group were lower than those in the conventional group, and the scores of libido, sexual arousal, orgasm, vaginal lubrication and sexual satisfaction were higher than those in the conventional group (P<0.05). Conclusions LUC is a safe and effective treatment for patients with moderate and severe metroptosis. Compared with conventional LUC, MLUC is simpler, with less bleeding shorter operation time and hospital stay, lower postoperative complications, and better improvement effect on the patients’ quality of life, which is worthy of further promotion and application.

Key words: Modified laparoscopic Uterosacral fixation;　Middle pelvic defect;　Clinical effect, Complication;　Quality of life

中图分类号:

R711.23

艾小燕, 　朱奕融, 　柯灿灿, 　余玉杰. 改良腹腔镜子宫骶骨固定术对中重度子宫脱垂患者的疗效研究[J]. 中国临床解剖学杂志, 2021, 39(5): 613-618.

Ai Xiaoyan, Zhu Yirong, Ke Cancan, Yu Yujie. Study on the effect of modified laparoscopic uterosacral fixation on the treatment of moderate and severe metroptosis[J]. Chinese Journal of Clinical Anatomy, 2021, 39(5): 613-618.

参考文献 17

[1]	Whitis AA, Lipinski SW, Bradley CS, et al. Association of vulvar symptoms with pelvic organ prolapse and urinary incontinence[J]. J Low Genit Tract Dis, 2017, 21(4): 315-318. DOI: 10.1097/LGT.0000000000000339.
[2]	Özengin N, Kaya S, Orhan C, et al. Turkish adaptation of the pelvic organ prolapse symptom score and its validity and reliability[J]. Int Urogynecol J, 2017, 28(8): 1217-1222. DOI: 10.1007/s00192-016-3251-x.
[3]	Khalife T, Hanna RK. The K-Technique: a novel technique for laparoscopic apical suspension using barbed sutures[J]. Female Pelvic Med Reconstr Surg, 2017, 23(2): 157-161. DOI: 10.1097/SPV.0000000000000381.
[4]	Lizee D, Campagna G, Morciano A, et al. Laparoscopic sacral colpopexy: how to place the posterior mesh into rectovaginal space[J]? Neurourol Urodyn, 2017, 36(6): 1529-1534. DOI: 10.1002/nau.23106.
[5]	潘珂, 曹莉莉, 王延洲, 等. 腹腔镜下子宫/阴道骶骨固定术与改良全盆底功能重建术治疗中盆腔缺陷的疗效比较[J]. 第三军医大学学报, 2015, 37(6): 573-577. DOI: 10.16016/j.1000-5404.201409038.
[6]	中华医学会妇产科学分会妇科盆底学组. 盆腔器官脱垂的中国诊治指南(草案)[J]. 中华妇产科杂志, 2014, 49(9): 647-651. DOI: 10.3760/cma.j.issn.0529-567x.2014.09.002.
[7]	Boyd SS, O'Sullivan D, Tulikangas P. Use of the Pelvic Organ Quantification System (POP-Q) in published articles of peer-reviewed journals[J]. Int Urogynecol J, 2017, 28(11): 1719-1723. DOI: 10.1007/s00192-017-3336-1.
[8]	Utomo E, Blok BF, Steensma AB, et al. Validation of the pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7) in a dutch population[J]. Int Urogynecol J, 2014, 25(4): 531-544. DOI: 10.1007/s00192-013-2263-z.
[9]	李青, 远丽, 徐青. 女性性功能指数调查量表FSFI的使用现状与评分方法[C]//北京: 北京国际康复论坛, 2014.
[10]	王玉玲, 柳晓春, 谢庆煌, 等. 腹腔镜下高位宫骶韧带悬吊术与经阴道骶棘韧带固定术治疗年轻子宫脱垂患者的临床效果评价[J]. 实用妇产科杂志, 2014, 30(4): 273-277. CNKI: SUN:SFCZ.0.2014-04-017.
[11]	Bradley MS, Bickhaus JA, Amundsen CL, et al. Vaginal uterosacral ligament suspension: a retrospective cohort of absorbable and permanent suture groups[J]. Female Pelvic Med Reconstr Surg, 2018, 24(3): 207-212. DOI: 10.1097/SPV.0000000000000451.
[12]	Matsuhashi T, Nakanishi K, Hamano E, et al. Laparoscopic repair of vaginal evisceration after abdominal hysterectomy for uterine corpus cancer: a case report and literature review[J]. J Nippon Med Sch, 2017, 84(2): 90-95. DOI: 10.1272/jnms.84.90.
[13]	Lizee D, Campagna G, Morciano A, et al. Laparoscopic sacral colpopexy: How to place the posterior mesh into rectovaginal space?[J]. Neurourol Urodyn, 2016, 36(6):1529-1534. DOI:10.1002/nau.23106.
[14]	鞠蕊, 杨欣, 孙秀丽, 等. 老年重度盆腔器官脱垂患者阴道完全封闭术与阴道部分封闭术围手术期情况比较[J]. 中华妇产科杂志, 2019, 54(1): 33-37. DOI: 10.3760/cma.j.issn.0529-567x.2019.01.014.
[15]	梁雪早, 徐丽珍, 陈礼全, 等. "阴腹联合"腹腔镜阴道骶骨固定术治疗Ⅳ度盆腔器官脱垂的中期疗效[J]. 中华妇产科杂志, 2019, 54(3): 160-165. DOI: 10.3760/cma.j.issn.0529-567x.2019.03.004.
[16]	Frigerio M, Manodoro S, Palmieri S, et al. Risk factors for stress urinary incontinence after native-tissue vaginal repair of pelvic organ prolapse[J]. Int J Gynaecol Obstet, 2018, 141(3): 349-353. DOI: 10.1002/ijgo.12443.
[17]	Rapp DE, Dolat ME, Wiley J, et al. Effect of concurrent prolapse surgery on stress urinary incontinence outcomes after TVTO[J]. Female Pelvic Med Reconstr Surg, 2017, 23(4): 244-249. DOI: 10.1097/SPV.0000000000000364.