改良前盆底重建术联合骶棘韧带悬吊术在女性前盆腔器官脱垂分析

目的：评价改良前盆底重建术联合骶棘韧带悬吊术在女性前盆腔器官脱垂中的效果，评价其疗效及安全性。方法：回顾性分析2010年1月-2012年7月于重庆市妇幼保健院就诊的55例单纯前盆腔器官脱垂患者盆腔器官脱垂定量评价系统（POP-Q）分期Ⅲ期或Ⅳ期]，其中17例施行改良前盆底重建术联合骶棘韧带悬吊术（联合组），18例施行单纯改良前盆底重建术（重建组），20例施行传统阴道前壁修补术（传统组）。结果：3组患者手术时间、术中出血量、术后住院时间差异有统计学意义（均P＜0.05）。3组患者术后1个月治愈率差异无统计学意义，3组术后3，6个月治愈率差异有统计学意义（P＜0.05）。联合组和重建组术后无血肿发生，无尿道、膀胱及直肠损伤；传统组术后有3例出现尿潴留，给予对症处理后恢复正常。结论：改良前盆底重建术联合骶棘韧带悬吊术较单纯改良前盆底重建术可更有效治疗前盆腔器官脱垂，修补缺陷，恢复盆底结构，短期疗效安全可行，长期疗效有待进一步观察。

Analysis on Anterior Pelvic Organ Prolapse Treated by Improved Anterior Pelvic Reconstruction Combined with Sacrospinous Ligament Suspension

Objective： To evaluate the clinical efficacy and safety of the improved anterior pelvic reconstruction combined with sacrospinous ligament suspension in treatment of anterior pelvic organ prolapse. Methods：55 cases with anterior pelvic organ prolapse （stageⅢor stageⅣaccording to POP-Q staging） from January 2010 to July 2012 were retrospectively analyzed. 17 cases received the improved anterior pelvic reconstruction and sacrospinous ligament suspension （the combination group）,18 cases received only the improved anterior pelvic reconstruction （the reconstruction group）,and 20 cases received the vaginal antetheca repair （the routine treatment group）. Results：There were significant differences in the average operation time,the amount of blood loss, and hospitalization day after operation in the three groups （P〈0.05）. There was no significant difference in the curative rate of one month after operation in the three groups ,but the curative rate of 3 and 6 months after operation in the combination group was significantly higher than those in others groups （P〈0.05）. In the combination group and the reconstruction group, there were not adverse effects such as hematoma ,urethra,bladder and rectum injury. However,there were 3 cases with the postoperative urinary retention in the routine treatment group. They recovered by heteropathy. Conclusions：The improved anterior pelvic reconstruction combined with sacrospinous ligament suspension can successfully repair defects of the anterior pelvic structure with better short-term efficacy, safe and feasible. However ,its long-term efficacy needs further observation.