腹腔镜骶骨阴道固定术的疗效临床分析

目的探讨腹腔镜骶骨阴道固定术(laparoscopic sacral colpopexy,LSC)治疗盆腔器官脱垂(pelvic organ prolapsed,POP)的疗效、安全性及并发症。方法广西医科大学第一附属医院(西院)于2010年2月至2011年8月对16例中重度POP患者进行了LSC治疗,其中4例合并压力性尿失禁(urinary stress incontinence,SUI)同时行阴道无张力尿道中段悬吊术(tension free vaginal tape-obturator,TVT-O),7例行阴道前后壁修补术。观察手术时间、术中出血、术后发热、膀胱功能恢复、住院时间等,以了解手术安全性。比较手术前后POP分度评价POP的解剖学改善情况;比较手术前后盆底功能影响问卷简表(the pelvic floor impact questionnaire,PFIQ-7)和盆底不适调查表简表(the pelvic floor distress inventory,PFDI-20)评分及POP-尿失禁性生活问卷(the pelvic organ prolapse/urinary incontinence sexual function questionnaire,PISQ)评分,评价手术对患者生命质量和性生活质量的影响。通过随访了解术后并发症的发生情况。结果手术时间(225.36±38.40)min,术中出血量(385.35±240.30)ml,术后体温均未超过38.5℃,住院时间(7.5±2.3)d,留置尿管时间(4.2±1.6)d。术后POP-Q分度较术前明显改善,PFIQ-7和PFDI-20评分较术前显著降低,PISQ评分较术前显著升高,差异均有统计学意义(P<0.05)。随访6～24个月,平均(14.8±6.2)个月,有3例出现性交不适及性交痛,未见网片侵蚀、暴露、感染等并发症,无新发SUI。客观治愈率100.0%,主观治愈率81.3%。结论 LSC是一种微创、安全、有效的手术方式。

Clinical analysis of efficiency on laparoscopic sacral colpopexy

Objective To study clinical efficiency, safety and complication of laparoscopic sacral colpopexy （LSC） for pelvic organ prolapse（POP）. Methods Total 16 patients with POP were underwent LSC in Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University （ West Courtyard） , between February 2010 to August 2011. Four patients complicated with urinary stress incontinence （SUI） were underwent tension free vaginal tape - obturator system （TVT - O ）. Seven patients were underwent colporrhaphia anterior - posterior. The data about reviewing operative time, blood loss volume of LSC, febricity after surgery, post operative stay time and recovery of bladder function, intestinal function were used to evaluate the surgical safety. Comparison of pelvic organ prolapse quantitative examination （POP- Q） in these patients before and after the surgery was used toevaluate anatomic improvement. The data of pelvic floor impact questionnaire - short form 7 （ PFIQ - 7 ） and pelvic floor distress inventory - short form 20 （ PFDI - 20） in these patients before and after the surgery was compared to evaluate quality of life. The data of pelvic organ prolapse - urinary incontinence sexual questionnaire （PISQ） in these patients before and after surgery was compared to evaluate of sexual life. Statistical delineation and t - test were used to analyze. Results Operative time was （225.36 ~38. 40） minutes,blood loss volume of LSC was （385. 35 ~240. 30） ml, the highest temperature was less than 38. 5 ℃, postoperative stay - time was （ 7. 5 ± 2. 3 ） days, time of indwelling urinary catheter was （4. 2 ± 1.6） days ,the follow - up time was （ 14. 8 ±6. 2） months,POP - Q examination after the surgery was significantly improved（P 〈 0.05）. The scores of PFIQ -7 and PFDI -20 after the treatment were lower than those before the treatment （ P 〈 0. 05 ）. The scores of PISQ after the treatment was higher than that before the treatment （ P 〈 0. 05 ）. The rate of dyspareunia was 18.3 % in the follow - up period. In this series, mesh exposure and erosion rate was none. The postoperative de novo stress incontinence rate was none. The objective cure rate was 100.0% and the subjective cure rate was 81.7%. Conclusion LSC appears to be a microinvasive, security and effective surgery for POP.