盆底重建术治疗盆底脏器脱垂的疗效观察

目的:评价盆底功能障碍性疾病(PFD)两种手术方法治疗效果。方法:回顾性分析PFD 58例中32例行阴式子宫切除及阴道前后壁修补术(传统组),26例行保留子宫的盆底重建经及闭孔尿道中段无张力悬吊术(重建组),比较两组手术时间、术中出血、排气时间、住院时间、术后病率及疗效等情况及术后的恢复情况、并发症和临床疗效,并随访其复发率及生活满意度。结果:重建组手术时间、术中出血、排气时间、术后病率分别是(75.4±20.5)min、(69.2±17.7)ml、(27.1±6.3)h、(6.7±0.3)天、2.78%;传统组分别为(138.7±18.6)min、(145.2±44.7)ml、(44.6±4.8)h、(11.4±0.4)天、9.38%,两组差异均有统计学意义(P<0.05)。重建组及传统组总有效率分别为96.78%和76.00%。重建组明显优于传统组(P<0.05)。26例重建组患者手术前后POP-Q指标变化评分,阴道总长度在健康状况、盆腔器官脱垂对其角色、体力、社交、个人关系、情绪及睡眠、性生活影响,脱垂严重程度等方面,术后较术前均显著改善(P=0.000～0.007)。结论:保留子宫的盆底重建及经闭孔尿道中段无张力悬吊术治疗PFD手术时间短、出血少、疗效好、复发率低、技术易掌握,值得推广。

Observation on the curative effect of pelvic floor reconstruction operation for treatment of pelvic organ prolapse

Objective:To evaluate the curative effects of two surgical methods for treatment of pelvic floor dysfunction(PFD). Methods:The clinical data of 32 PFD patients treated with transvaginal hysterectomy plus vaginal anterior wall and posterior wall repair(routine group) and 26 PFD patients treated with uterus-preserved pelvic floor reconstruction operation plus transobturator tension-free vaginal tape-obturator(TVT-O)(reconstruction group) were analyzed retrospectively;the operation times,the amounts of blood loss during operation,the exhaust times,the hospitalization times,the postoperative morbidities,the curative effects,the recovery situations after operation,complications,and clinical curative effects in the two groups were compared,the recurrence rates and life satisfaction indexes in the two groups were followed up. Results:The operation time,the amount of blood loss during operation,exhaust time,hospitalization time,and postoperative morbidity in reconstruction group were(75.4±20.5) minutes,(69.2±17.7) ml,(27.1±6.3) hours,(6.7±0.3) days,and 2.78%,respectively;while in routine group,the indexes were(138.7±18.6) minutes,(145.2± 44.7) ml,(44.6±4.8) hours,(11.4±0.4) days,and 9.38%,respectively,there was statistically significant difference between the two groups(P<0.05).The total effective rates in reconstruction group and routine group were 96.78% and 76.00%,respectively,the curative effect in reconstruction group was superior to that in routine group(P<0.05).In reconstruction group,the score of pelvic organ prolapse(POP)-Q index,the total length of healthy vagina,the effect of POP on the role,physical strength,social intercourse,personal relationship,emotion,sleeping,and sexual life,the degree of severity of POP after surgery were significantly better than those before surgery(P=0.000-0.007). Conclusion:Uterus-preserved pelvic floor reconstruction operation plus TVT-O had the advantages of short time,less bleeding,good curative effect,low recurrence rate,and easy to operate for treatment of PFD,which are worthy to be popularized.