摘要
目的探讨硅胶子宫托和盆底重建术两种不同方式改善老年女性重度盆腔器官脱垂患者生活质量的差异,并对治疗后满意度及并发症进行分析,为老年患者治疗方式的选择提供临床依据。方法选取2013年1月~2014年5月就诊于郑州大学第三附属医院有症状、要求治疗的144例老年POP-QⅢ~Ⅳ度的患者为研究对象。按治疗方式分为硅胶子宫托组和盆底重建术组,应用盆底功能障碍问卷PFDI-20和盆底障碍影响简易问卷PFIQ-7对患者治疗前、治疗后6个月、2年的生活质量评分进行组间、组内比较,并对治疗后满意度及并发症进行分析。结果 144例POP患者中,选择硅胶子宫托者55例(38.19%),手术者89例(61.81%)。PFDI-20、PFIQ-7治疗前组间差异无统计学意义(P>0.05),组内比较治疗后6个月、2年与治疗前差异均有统计学意义(P<0.05),组间比较治疗后6个月差异无统计学意义(P>0.05),治疗后2年子宫托组评分高于盆底重建术组,差异有统计学意义(P<0.05)。并发症:子宫托组:阴道分泌物增多10例(21.28%),阴道异味5例(10.64%);盆底重建术组围手术期:穿刺点或下肢牵拉痛11例(13.92%),尿潴留7例(14.29%);术后远期:网片外露11例(13.92%),新发尿路症状8例(10.13%)。治疗后满意度6个月组间比较,差异无统计学意义(P>0.05),治疗后2年手术组高于子宫托组,差异有统计学意义(P>0.05)。结论硅胶子宫托与盆底重建术均为有效治疗方法,但盆底重建术远期治疗满意度高于子宫托。对于高龄重度盆腔脏器脱垂患者围术期并发症较高、网片外漏发生率增加高,尤其是不能耐受手术或者不愿手术治疗的患者,硅胶子宫托是一种值得推荐的治疗方法。
Objective To investigate the differences of improving of life quality, the satisfaction after treatment and complications between silicone pessary and pelvic floor reconstruction for old patients with severe pelvic organ prolapse（POP） , and provide clinical evi- dence of the selection of treatment for old patients. Methods To select 144 cases of POP - Q Ⅲ - Ⅳ patients in elderly women at The Third Affiliated Hospital of Zhengzhou University, who were affected by the POP symptoms and came to our clinic for treatment from Janu- ary 2013 to May 2014. According to treatment, the patients were divided into silicone pessary and pelvic floor reconstruction groups. Two groups were assessed the life quality of patients before treatment, 6 months and 2 years after treatment with Pelvic Floor Distress Inventory - short form 20 （PFDI - 20） , pelvic floor impact questionnaire short form （ PFIQ - 7） , and compared with it within group and between groups, and analyzed the satisfaction and complications. Results There were 55 （38.19%） patients in the surgical group and 89 （61.81% ） patients in the pessary group. There was no statistically significant difference between two groups of PFDI -20 and PFIQ - 7 before treatment （P 〉 0. 05）. Within group, there was statistically difference of PFDI - 20 and PFIQ - 7 between 6 month after treatment and before treatment （P 〈 0. 05）, and between 2 years after treatment and before treatment （ P 〈 0.05 ）. Between two groups, the score of PFDI - 20 and PFIQ - 7 in 6 month after treatment was no statistically difference with before treatment （ P 〉 0.05 ）. In 2 years af- ter treatment, the score of pessary group was higher than that of surgery （ P 〈 0.05 ）. The main complications of pessary group include in- creased discharge （21.28%）, vaginal odor （10.64%）. Perioperative complications of surgery group include the puncture point or lower extremities pull pain （ 13.92% ） and urinary retention （ 14.29% ）. Postoperative complication include mesh exposure（ 13.92% ） and new urinary tract symptoms （10.13%）. Satisfaction scores was no statistically difference between groups two after 6 months （P 〉 0.05）. After 2 years, the satisfaction scores of surgery group was higher than pessary group（P 〈 0. 05 ）. Conclusion Silicone pessary and pelvic floor revascularization are effective treatment for POP, but the satisfaction after treatment of surgery is higher than that of pessary. For elderly patients with severe pelvic organ prolapse, perioperative complications and the incidence of mesh exposure is higher. Pessary is a recommended treatment for the patients who can＇t tolerate surgery or aren＇t unwilling to suffer from surgery.
出处
《医学研究杂志》
2017年第4期32-35,共4页
Journal of Medical Research
基金
国家科技支撑计划项目(2014BAI05B02)
关键词
盆腔脏器脱垂
硅胶子宫托
盆底重建术
生活质量
并发症
满意度
Pelvic organ prolapse
Silicone pessary
Pelvic floor reconstruction
Quality of life
Complications
Satisfaction
