腹腔镜下子宫-阴道骶骨固定术联合多部位修复术治疗中重度盆腔器官脱垂37例临床分析

目的 探讨多术式联合治疗盆腔器官脱垂（POP）的疗效、安全性及并发症。方法 回顾性分析2007年9月至2012年12月在沈阳市妇婴医院联合应用聚丙烯网片腹腔镜下子宫-阴道骶骨固定术联合改良的阴道旁修补术、圆韧带短缩术、骶韧带缩短术治疗的37例中重度POP患者的临床资料。其中合并糖尿病3例，9例合并宫颈延长（行宫颈部分切除术）,合并压力性尿失禁（SUI）9例，合并子宫肌瘤、腺肌病、卵巢囊肿16例（其中2例多发肌瘤、6例单发肌瘤者希望保留子宫，术中同时行肌瘤剔除术；6例行子宫次全切除术；2例卵巢囊肿患者术中行囊肿切除术，术中冰冻病理良性）。既往行子宫次全切除术4例，行子宫全切术1例。患者均有程度不等的性生活不适或性交困难。观察手术时间、术中出血、膀胱功能恢复等，并在术后定期随访，对手术效果进行主客观评价。结果 37例患者盆腔器官脱垂定量系统（POP-Q）分期Ⅱ期10例，Ⅲ期19例，Ⅳ期8例。所有患者经多术式联合治疗均获成功，平均手术时间(153±32)min,平均出血量（185.35±58.40）mL，术后留置尿管(3.0±1.5)d。术后1年复查POP-Q评分较术前明显改善：Aa－2.4 ±0.5，Ba－2.8±0.4，C－7.5±0.9，Ap－2.5±0.5，Bp－2.6±0.4,相关症状消失或明显改善，无性生活不适及性交痛，无网片侵蚀、暴露、感染等并发症。客观治愈率100%。结论 腹腔镜下子宫-阴道骶骨固定术联合多部位修复术治疗盆腔器官脱垂是一种微创、安全、有效的治疗方式。

The clinical analysis of combined multiple surgical methods in treating 37 cases of pelvic organ prolapse.

Abstract： Objective To analyze the efficacy ,safety and complication of the combination of the traditional surgery with the laparoscopic suspension surgery for pelvic organ prolapse. Methods The present study is a retrospective analysis of the clinical data of 37cases of pelvic organ prolapse receiving surgical treatment in our hospital from September 2007 to December 2012，POP-QⅡ 10cases，POP-QⅢ 19 cases，POP-QⅣ8 cases.All patients underwent the laparoscopic sacral copopexy and traditional vaginal anterior and posterior wall patch，cervical partial amputaton for those 9 patients with cervical extend ,combined laparoscopic sacral ligament fusion，and the round ligament shorten ing with mesh suspension reconstructive pelvic surgery，and 9 patients complicated with severe stress urinary incontinence(SUI) were given transobturator tension-free vaginal tape(TVT-O).Six patients underwent subtotal hysterectomy and 8 patients underwent myomectomy to retain the uterus.The therapeutic effect,the mean operation time,blood loss,time of micturation were observed.Results All the operations were completed successfully.The mean operation time was(153±32)min,the mean blood loss（185.35±58.40）mL ，time of micturation(3.0±1.5)d and ,the follow up duration was 12～53 months.One year of follow-up showed,Aa point －2.4±0.5.Ba point －2.8±0.4，point C －7.5±0.9，Ap point －2.5±0.5 Bp point －2.6±0.4，which were significantly better than that before surgery. All P <0.05. There is no recurrence or erosion and infection or vaginal exposure of path in this group of patients after 1 year.The symptoms of all patients have been alleviated.