腹壁自体筋膜盆底悬吊术与腹腔镜下子宫颈悬吊术治疗盆底器官脱垂的疗效观察

目的:探讨腹壁自体筋膜盆底悬吊术与腹腔镜下子宫颈悬吊术治疗盆底器官脱垂的临床应用价值及对生活质量的影响。方法:将60例盆底器官脱垂患者随机分为观察组与对照组,每组30例,观察组行腹壁自体筋膜盆底悬吊术,对照组行腹腔镜下子宫颈悬吊术,应用盆腔器官脱垂定量分度法评估手术效果。术后6个月采用盆底功能障碍问卷短表对患者生活质量进行调查,采用盆腔器官脱垂尿失禁性功能问卷对患者性生活质量进行调查。结果:观察组手术时间[(72.32±8.34)min]、术中出血量[(57.43±8.52)ml]、尿管留置时间[(3.23±0.54)d]、术后住院时间[(7.32±0.69)d]均多于对照组[(53.34±6.88)min、(45.65±7.43)ml、(2.39±0.87)d、(6.27±0.75)d],差异有统计学意义(P0.01),术后两组Aa、Ba、C、D、Ap、Bp等指示点位置术后均较术前明显上升,其中观察组上升水平明显高于对照组,更接近解剖学位置(P0.01),盆底功能障碍问卷、排便功能障碍问卷及泌尿功能障碍问卷评分观察组明显低于对照组,盆腔器官脱垂尿失禁性功能问卷中情感、生理、总分等观察组均高于对照组(P0.05)。结论:腹壁自体筋膜盆底悬吊术与腹腔镜下子宫颈悬吊术在治疗盆底器官脱垂中均具有良好的临床治疗效果,其中腹壁自体筋膜盆底悬吊术治疗盆底器官脱垂恢复盆底器官解剖更理想,对患者术后生活质量影响较小。

Clinical observation of treating pelvic organ prolapse by abdominal autologous fascia pelvic floor suspension and laparoscopic cervical suspension

Objective:To study the clinical application value and influence on life quality of the abdominal autologous fascia pelvic floor suspension and laparoscopic cervical suspension in treating severe pelvic organ prolapse (POP).Methods:Sixty patients with POP were randomly divided into observation group and control group (30 cases in each).Patients in observation group received abdominal autologous fascia pelvic floor suspension,while patients in control group received laparoscopic cervical suspension.Pelvic organ prolapse quantitation (POP-Q) was applied to evaluate the operation result;six months after operation,pelvic floor distress inventory 20 (PFDI-20) was adopted to survey the patients' life quality;pelvic organ prolapse urinary incontinence sexual questionnaire-short form 12 (PISQ-12) was used to survey the quality of patients' sexual life.Results:The observation group had significantly longer operation time [(72.32 ± 8.34) min],more blood loss [(57.43 ± 8.52) ml],longer time of ureter retention [(3.23 ± 0.54) d],and longer postoperative length of stay [(7.32 ± 0.69) d] than the control group [(53.34 ± 6.88) min,(45.65 ± 7.43) ml,(2.39 ± 0.87) d,(6.27 ± 0.75) d,P ＜ 0.01]).The indication points such as Aa,Ba,C,D,Ap and Bp ascended obviously after operation compared with that before operation;the rising level in observation group was higher than that in control group and was much closer to anatomical location (P ＜ 0.01).The scores of questionnaires of pelvic function dysfunction,defecation dysfunction and urinary dysfunction in observation group were obviously lower than those in control group (P ＜ 0.05).In the PISQ-12 questionnaire,the scores of emotion,physiology and total points of patients in observation group were higher than those in control group (P ＜ 0.05).Conclusions:Both abdominal autologous fascia pelvic floor suspension and laparoscopic cervical suspension obtain the good treatment effect.Meanwhile,abdominal autologous fascia pelvic floor suspension performs better in treating POP and recovering pelvic organ anatomy,and has less influence on patients' postoperative life quality.