两种保留子宫治疗子宫脱垂的手术方式的疗效分析

目的:探讨腹腔镜下子宫腹壁悬吊术及子宫骶骨岬悬吊术治疗要求保留子宫的女性盆腔脏器脱垂患者的可行性及临床疗效。方法:回顾分析2012年6月1日至2013年6月1日郑州大学第一附属医院收治的64例要求保留子宫的子宫脱垂患者的临床资料,其中34例行腹腔镜下子宫腹壁悬吊术(研究组),30例行子宫骶骨岬悬吊术(对照组)。比较两组患者的手术时间、术中出血量、住院天数及术后并发症,术后12个月测量患者POP-Q各点值评价术前术后盆底功能改善状况,以盆底不适调查表短表20(PFDI-20)评价手术前后患者的生活质量。结果:64例患者均经腹腔镜成功完成手术,术中无膀胱、输尿管、直肠损伤。研究组的手术时间、术中出血量、住院天数均少于对照组,差异均有统计学意义(P0.05)。术后随访12个月,两组患者均无子宫脱垂复发,POP-Q各点测量值差异无统计学意义(P0.05);两组的术前与术后生活质量调查表问卷得分比较,差异有统计学意义(P0.05)。研究组和对照组分别有3例(8.8%)和2例(6.7%)发生术后并发症。结论:腹腔镜下腹壁子宫悬吊术及子宫骶骨岬悬吊术治疗子宫脱垂安全有效;腹腔镜下腹壁子宫悬吊术具有手术时间短、术中出血量少、经济安全、术后并发症少等优点,有望临床推广。

Analysis of the efficacy of the two operation methods for the treatment of uterine prolapse with keeping the intergrity of the uterine

Objective: To compare the curative effect of laparoscopic ventrosuspension of uterus and uterine sacral fixation in the treatment of the uterine prolapse with desire for uterine preservation.Methods: A retrospective analysis of 64 patients with uterine prolapse,and with desire for uterine preservation in the First Affiliated Hospital of Zhengzhou University from June2012 to June 2013.Among them 34 received the ventrosuspension of uterus and 30 underwent uterine sacral promontory suspension. The operation time、blood loss 、postoperative hospital stay and complications were compared. After 12 months,Measuring the POP-Q value at every point to assess preoperative postoperative pelvic floor function. Results: All procedures were successfully completed laparoscopicaly.The operation time,blood loss,postoperative hospital stay of the team were less than the control group,the differences had statistical significance( P<0.05).The POP-Q indexing instructions point had no significant difference between the two groups( P<0.05).The two groups both have improvement in the prolapse and urinary subscales of the PFDI-20 at 12 months after surgery( P < 0. 05). None of the women had recurrent uterine prolapse.Conclusion: The two types of surgery for uterine prolapse are both effective.The ventrosuspension of uterus have the advantage of small trauma,less bleeding,faster recovery and less cost,it is expected to be promoted in clinic.