Prolift盆底重建术治疗重度盆腔器官脱垂患者预后影响因素分析

目的探讨Prolift盆底重建术治疗重度盆腔器官脱垂(pelvic organ prolapse,POP)的临床效果及其术后复发的危险因素。方法选取2013年6月至2015年6月在深圳市人民医院行Prolift盆底重建术治疗的168例POP患者,分别于术前、术后1年应用POP-Q分度法及POP生活质量问卷(P-QOL)对患者POP程度及生活质量进行评价,观察其术后1年复发情况,并应用Cox风险模型分析Prolift盆底重建术治疗POP术后复发的危险因素。结果 168例患者治愈率为94.05%(158/168),术后1年复发率为12.50%(20/160)。POP患者术后1年POP-Q分度为Ⅲ~Ⅳ°比例较治疗前显著下降(P0.05)。POP患者术后1年脱垂严重程度、个人关系、健康状况、生活状况、角色、体力、社交、情绪、睡眠等方面评分较术前均显著下降(P0.05)。经Cox风险模型分析显示,疾病严重程度为Ⅲ~Ⅳ°、脱垂部位为前盆腔、术后阴道壁长度5 cm是Prolift盆底重建术治疗POP术后复发的独立危险因素。结论 Prolift盆底重建术治疗POP可获得较高的治愈率,能有效改善患者术后生活质量。疾病严重程度为Ⅲ~Ⅳ°、脱垂部位为前盆腔、术后阴道壁长度5 cm是Prolift盆底重建术治疗POP术后复发的独立危险因素,对于具备危险因素的患者术后应加强随访,以降低POP复发率。

Prognostic factors of patients with severe pelvic organ prolapse by prolift pelvic reconstruction

Objective To investigate the clinical effects and risk factors of recurrence of the prolift pelvic reconstruction for severe pelvic organ prolapse ( POP ) . Methods 168 cases of POP with prolift pelvic floor reconstruction treatment in Shenzhen People’ s Hospital from June 2013 to June 2015 were selected. The POP extent and quality of life of 168 cases were assessed with POP-Q indexing and POP quality of life questionnaire (P-QOL) before and 1 year after surgery. To observe the recurrence of 1 year postoperatively, and the risk factors of postoperative recurrence of POP were analyzed by Cox risk model. Results The cure rate of 168 patients was 94. 05% (158/168), recurrence rate after 1-year was 12. 50% (20/160). TheⅢ ~ Ⅳ° proportion of POP with prolift pelvic floor reconstruction treatment after one year were significantly lower than before treatment ( P <0. 05 ) . Cox analysis showed, the scores of prolapse, personal relationships, health, living conditions, roles, physical, social, emotional, sleep and other aspects one year after treatment were lower than before treatment (P<0. 05). The POP-Q Ⅲ ~ Ⅳ, former site of pelvic prolapse, and vaginal wall length>5cm were independent risk factors of recurrence of POP after prolift reconstructive treatment. Conclusion Prolift pelvic reconstruction can improve the cure rate of POP and effectively improve patients’ life quality. Disease severityⅢ~Ⅳ°, the former site of pelvic prolapse and vaginal wall length>5cm are independent risk factors for recurrence of POP after prolift pelvic reconstruction. Postoperative follow-up should be strengthened to reduce the recurrence rate.