阴道全封闭术联合会阴体重建术治疗老年重度盆腔器官脱垂的疗效

目的探讨阴道全封闭术联合会阴体重建术治疗老年重度盆腔器官脱垂（POP）的临床效果以及手术对患者生活质量的影响。方法回顾性分析在郑州大学第三附属医院就诊并因Ⅲ～Ⅳ度POP行阴道全封闭术患者临床资料，按照手术方式分为单纯阴道全封闭组及阴道全封闭联合会阴体重建组，其中单纯阴道封闭组共完成随访28例，阴道全封闭术联合会阴体重建组共完成随访32例。通过分析手术时间、术中出血量、住院时间、术后拔除尿管时间、术后残余尿及围手术期并发症评介阴道全封闭术联合会阴体重建术的安全性。采用盆底功能障碍问卷（盆腔、下尿路和肠道的症状恢复情况）评判两组患者生活质量改善情况。结果阴道全封闭术联合会阴体重建术患者与单纯阴道封闭组患者比较手术时间、术中出血量、住院时间、术后拔除尿管时间、术后残余尿及围手术期并发症差异无统计学意义（P>0.05)。所有病例均无手术失败，无术后脱垂复发。所有患者POPDI-6评分、UDI-6评分、CRADI-8评分术前、术后比较差异有统计学意义(P<0.05)，盆腔、下尿路及排便困扰症状术后明显改善。阴道全封闭术联合会阴体重建术组术后CRADI-8评分较单纯阴道封闭组分值更低，术后结直肠肛门困扰症状改善更明显。结论阴道全封闭术联合会阴体重建术治疗老年重度POP安全有效，可改善重度POP患者盆腔、下尿路、肠道困扰症状，显著改善患者的生活质量。

The clinical effect of total colpocleisis combined with perineal reconstruction in the treatment of elderly patients with severe pelvic organ prolapse

Objective To evaluate the clinical effect of total colpocleisis combined with perineal reconstruction in the treatment of elderly patients with severe pelvic organ prolapse (POP) and the impact of surgery on the quality of life. Methods The clinical data of patients received total colpocleisis for Ⅲ-ⅣPOP were retrospectively analyzed. The patients were divided into the group of total colpocleisis and the group of total colpocleisis combined with perineal reconstruction. A total of 28 cases were followed up in the total colpocleisis group, and 32 cases were followed up in the total colpocleisis combined with perineal reconstruction group. The safety of total colpocleisis combined with perineal reconstruction was evaluated by analyzing the operation time, intraoperative blood loss, hospital stay, postoperative catheter removal time, postoperative residual urine index and perioperative complications. The improvement in quality of life in both groups was assessed using the pelvic floor distress questionnaire (pelvic，urinary and colorectal-anal distress). Results There was no significant difference in operative time, intraoperative blood loss, hospital stay, postoperative catheter removal time, or postoperative residual urine index between the two groups. The differences in POPDI-6 score, UDI-6 score, and CRADI-8 score were statistically significant between before and after surgery in all patients (P<0.05), and the symptoms of pelvic, urinary and colorectal-anal distress were significantly improved after surgery. The scores of CRADI-8 after total colpocleisis combined with perineal reconstruction were lower than in the group of total colpocleisis, and the improvement of postoperative colorectal-anal distress symptoms was more obvious. Conclusion Total colpocleisis combined with perineal reconstruction is safe and effective in the treatment of severe POP in the elderly, and can improve the preoperative symptoms of pelvic, lower urinary tract and colorectal-anal distress in patients with severe POP, significantly improve the quality of life.