阴道前壁的自体组织Kelly术联合腹腔镜高位宫骶韧带悬吊术治疗重度前盆腔缺陷的疗效

目的探讨阴道前壁的自体组织Kelly术联合腹腔镜高位宫骶韧带悬吊术治疗重度前盆腔缺陷的疗效。方法2013年4月~2018年11月我院采用阴道前壁的自体组织Kelly术联合腹腔镜高位宫骶韧带悬吊术治疗178例重度前盆腔缺陷为主的盆腔脏器脱垂(pelvic organ prolapse,POP)并完成系统随访,即术后1、3、6、12个月及之后每年1次进行随访。客观疗效评价采用POP-Q定量分度法,主观疗效评价采用患者整体印象改善评分量表(Patient Global Impression of Improvement,PGI-I)、盆底不适调查表简表(Pelvic Floor Distress Inventory Short Form 20,PFDI-20)和盆底功能影响问卷简表(Pelvic Floor Impact Questionnaire Short Form 7,PFIQ-7)。手术成功的标准:术后POP-Q分度≤1度。性生活质量评价采用盆腔脏器脱垂/尿失禁性功能问卷(Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire,PISQ-12),术后新发神经痛患者的疼痛评估采用改良手术疼痛量表(Surgical Pain Scale,SPS)和视觉模拟量表(Visual Analogue Scale,VAS)。结果总手术时间(192.9±52.0)min,出血量(99.0±56.1)ml,留置尿管时间平均4.4 d(3~15 d),术后住院时间(7.1±3.6)d。无一例术后病率或输尿管、膀胱及直肠的损伤,无一例需要输血。178例中位随访时间34个月(8~75个月),手术成功率为99.4%(177/178),主观满意率为98.3%(175/178)。术前后POP-Q指示点Aa、Ba、C、Ap、Bp、gh、pb、TVL点差异均有显著性(P<0.05),术前后PFDI-20、PFIQ-7、PISQ-12评分差异均有显著性(P<0.05)。术后神经痛发生率为0.6%(1/178)。结论阴道前壁的自体组织Kelly术联合腹腔镜高位宫骶韧带悬吊术治疗重度前盆腔缺陷中期疗效满意。

Clinical Effect of Native Tissue Kelly Operation of Anterior Vaginal Wall Combined With Laparoscopic High Uterosacral Ligament Suspension in the Treatment of Severe Anterior Compartment Defects

Objective To investigate the therapeutic effect of native tissue Kelly operation of anterior vaginal wall combined with laparoscopic high uterosacral ligament suspension for severe anterior compartment defects.Methods From April 2013 to November 2018,178 POP patients with severe anterior compartment defects were treated with native tissue Kelly operation of anterior vaginal wall combined with laparoscopic high uterosacral ligament suspension in our hospital.A systematic follow-up was completed at 1,3,6,12 months after operation and once a year thereafter.Objective efficacy evaluation was conducted by POP-Q quantitative grading method,and subjective efficacy evaluation was conducted by Patient Global Impression of Improvement(PGI-I),Pelvic Floor Distress Inventory Short Form 20(PFDI-20)and Pelvic Floor Impact Questionnaire Short Form 7(PFIQ-7).The criteria for successful surgery was postoperative POP-Q index≤1 degree.The sexual life quality was evaluated by Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ-12),and the pain of postoperative neuralgia patients was evaluated by the improved Surgical Pain Scale(SPS)combined with Visual Analogue Scale(VAS).Results The total operation time was(192.9±52.0)min,the amount of bleeding was(99.0±56.1)ml,the average time of indwelling cateter was 4.4 d(range,3-15 d),and the postoperative hospital stay was(7.1±3.6)d.No postoperative fever,or injuries of ureter,bladder and rectum happened.No blood transfusion was needed.The median follow-up period was 34 months(range,8-75 months).The success rate of the operation was 99.4%(177/178),and the subjective satisfaction rate was 98.3%(175/178).Before and after operation,the measured values of POP-Q indicator points of Aa,Ba,C,Ap,Bp,gh,pb and TVL were significantly different(P<0.05),and the differences of PFDI-20,PFIQ-7,PISQ-12 before and after operation were statistically significant(P<0.05).The incidence of postoperative neuralgia was 0.6%(1/178).Conclusion Native tissue Kelly operation of anterior vaginal wall combined with laparoscopic high uterosacral ligament suspension has a satisfactory mid-term effect in the treatment of severe anterior compartment defects.