摘要
目的比较全盆底重建术与传统阴式子宫切除加阴道前后壁修补术在治疗重度盆腔器官脱垂(POP)中的临床疗效及对患者生活质量的影响。方法回顾性分析南京市妇幼保健院2008年1月至2009年12月收治的70例POP-QⅢ～Ⅳ期盆腔器官脱垂患者,并将其分为重建组(35例)和传统组(35例)。重建组采用全盆底重建术,其中14例患者因年纪较大,无保留子宫需求同时行阴式子宫切除术;传统组采用阴式子宫切除加阴道前后壁修补术。术后1个月、6个月、1年、2年进行随访,以盆底功能影响问卷简表(PFIQ-7)、盆底不适调查表简表(PFDI-20)和POP-尿失禁性生活问卷(PISQ)评价手术疗效及对患者生活质量的影响。结果①重建组平均手术时间为(108.3±29.4)min,平均术中出血量为(192.3±72.9)ml,平均保留导尿管时间(3.8±1.1)d,平均术后住院时间为(7.1±1.5)d,传统组分别为(127.0±18.5)min、(251.4±56.2)ml、(5.8±0.7)d和(9.0±2.4)d。以上各项指标两组比较,差异均有统计学意义(P<0.05)。②两组均无失访病例。重建组术后2年复发率为0(0/35),传统组为17.1%(6/35),两组比较,差异有统计学意义(P<0.05)。③重建组术前和术后2年PFIQ评分分别为(79.2±20.6)分和(3.9±5.2)分,传统组分别为(80.6±18.9)分和(20.4±12.8)分;重建组术前和术后2年PFDI评分分别为(73.7±17.1)分和(4.2±4.2)分,传统组分别为(78.2±19.1)分和(15.0±9.5)分,两组术后2年PFIQ和PFDI评分均较术前显著降低(P<0.05),且重建组术后2年PFIQ和PFDI评分均低于传统组(P<0.05)。④重建组术前13例患者有性生活,其术前PISQ评分[(65.7±8.1)分]与术后2年[(64.7±7.3)分]比较,差异无统计学意义(P>0.05)。传统组11例患者术前有性生活,术后9例患者由于手术原因拒绝性生活。结论与传统阴式手术比较,全盆底重建术复发率低,术后生活质量改善明显,对性生活影响小,值得临床推广。
Objective To explore the clinical effects and quality- of - life outcomes between total pelvic floor reconstruction surgery and traditional vaginal hysterectomy with vaginal anterior and posterior wall repair in treatment of severe pelvic floor prolapse （POP）. Methods From January 2008 to December 20~9, 70 POP patients （stage Ⅲ to IV according to POP- Q staging） were treated in our department, the clinical data was, analyzed retrospectively. Patients were divided into reconstruction group （35 cases） and routine group （35 cases）. In reconstruction group, 35 patients received total pelvic floor reconstruction, 14 of them underuent transvaginal hysterectomy at the same time because of old age, cervical lesion or no reserve uterine aspiration; in routine group, the patients received vaginal hysterectomy with colporrhaphia anterior and posterior. All patients were tracked and visited in 1 month, 6 months, 12 months and 24 months after surgery, the therapeutic effect and impact on quality- of- life were analyzed through scores of pelvic floor impact questionnaire - short form 7 （PFIQ- 7）, pelvic floor distress inventory- short form 20 （PFDI- 20） and pelvic organ prolapse- urinary incontinence sexual questionnaire （PISQ）.In routine group, 11 patients had sexual activity before surgery, but 9 of them refused intercourse after treatment, so PISQ could not be obtained. Results （DThe average operation times, the amounts of blood loss during operation, the times of indwelling urethral catheter and hospitalization time were （108. 3 ± 29.4） minutes, （192.3 ± 72.9） ml, （3.84±1.1） days and （7.1±1.5） days in reconstruction group and （127. 0=[=18. 5） minutes, （251.4± 56.2） ml, （5.8±0. 7） days, （9.0±2.4） days in routine group, differences were statistically significant （P〈 0. 05）. ②All cases were undre follow- up. The recurrence rate was 0 （0/35） in reconstruction group and 17.1~ （6/35） in routine group at 2 years after surgery （P〈0.05）. ③ In reconstruction group, the PFIQ scores before surgery and 2 years after surgery were （79.2±20.6） and （3.94±5.2）, while in routine group were （80. 6±18. 9） and （20.4±12. 8）. In reconstruction group, the PFDI scores before surgery and 2 years after surgery were （73. 7± 17.1） and （4. 24±4. 2）, while in routine group were （78. 24±19. 1） and （15.04±9. 5）. The PFIQ and PFDI scores in the two groups 2 years after gurgery were significantly lower than that before surgery （P〈0. 05）, and the PFIQ and PFDI scores 2 years after surgery in reconstruction group were significantly lower than that in routine group （P〈 0. 05）. ④ In reconstruction group, 13 patients had sexual activity before surgery, their PISQ score was （65. 694±8. 13） before surgery, which had no significant difference compared with that 2 years after surgery （64. 694±7.33, P 〉0. 05）. In routine group, 11 patients had sexual activity before surgery, but 9 of them refused intercourse after surgery because of operations. Conclusion Compared with routine transvaginal surgery, total pelvic floor recon- struction surgery had lower recurrence rate, can improve the quality of patients＇ lives more significantly, and had less impact on patients＇ sexualactivity.
出处
《中国妇产科临床杂志》
2013年第2期110-114,共5页
Chinese Journal of Clinical Obstetrics and Gynecology
关键词
盆腔器官脱垂
全盆底重建术
阴道前后壁修补术
子宫切除术
uterine prolapse
total pelvic floor reconstruction
repair of vaginal anterior and posterior wall：hysterectomy
