腹腔镜下腹股沟韧带悬吊术治疗中重度盆腔器官脱垂的疗效分析

目的:探讨腹腔镜下腹股沟韧带悬吊术(LILS)治疗中重度盆腔器官脱垂(POP)的临床疗效。方法:自2014年5月至2016年4月,收集上海市第一妇婴保健院收治的78例中重度子宫脱垂/阴道穹隆脱垂行LILS的患者。记录其围手术期指标如:手术时间、出血量、术中并发症,比较术前及术后12个月POP定量(POP-Q)分度法各指示点,并评价其解剖治愈率及复发率等。通过盆底功能障碍性疾病症状问卷简表(PFDI-20)及POP-尿失禁性生活问卷(PSIQ-12)评价主观治愈率以及术后性功能相关症状改善情况。结果:78例术前POP-Q分度为子宫脱垂/阴道穹隆脱垂Ⅲ~Ⅳ度患者中,行全子宫切除术+LILS 57例,行LILS患者21例。平均手术时间130.5分钟(82~190分钟),术中平均出血量51.3 ml(5~200 ml),平均住院时间6.2天(4~8天)。术中无严重的并发症发生。所有的患者获得至少12个月的随访,其客观治愈率93.6%(73/78),总复发率6.4%(5/78)。术后PFDI-20评分较术前明显提高,差异均有统计学意义(P<0.05)。PSIQ-12评分及有性生活患者的数量较术前明显提高,差异均有统计学意义(P<0.05)。结论:LILS用于治疗中重度POP的患者,其主客观治愈率高、手术并发症少、近期效果及性生活质量明显提高,远期疗效有待进一步研究。

The Effect Analysis of Laparoscopic Inguinal Ligament Suspension for the Repair of Mild and Severe Pelvic Organ Prolapse

Objective:To explore the clinical efficacy of Laparoscopic inguinal ligament suspension(LILS)in the treatment of mild and severe Pelvic Organ Prolapse(POP).Methods:78 cases with stageⅢ-Ⅳuterine prolapse/vaginal vault prolapse treated with LILS were enrolled between May 2014 and April 2016 in Shanghai First Infant and Maternity Hospital.The perioperative parameters including surgical time,blood loss and intraoperative complications were collected.The pelvic organ prolapse quantitation(POP-Q)system was assessed and compared before and 12 months after operation to evaluate the rate of anatomical cure and recurrence.The pelvic floor distress inventory short form(PFDI-20)and pelvic organ prolapse-urinary incontinence sexual questionnaire-12(PISQ-12)were used to evaluate the subjective prolapse function recovery as well as the sexual function.Results:In the 78 cases of stageⅢ-Ⅳuterine prolapse/vaginal vault prolapse determined by POP-Q before surgery,57 cases received hysterectomy and LILS,and the other cases received LILS only.The mean surgical time was 130.5 min(82-190 min),the mean estimated blood loss was 51.3 ml(5-200ml),and the mean hospi-tal stay was 6.2 days(4-8 days).No severe complications occurred during the surgery.All cases received a minimal 12 months follow-up.The overall anatomical success rate was 93.6%(73/78),and the recurrence rate was 6.4%(5/78).Postoperative PFDI-20 score increased significantly compared with that before surgery(P<0.05).The PISQ-12 score and the number of sexual active patients increased significantly after surgery(P<0.05).Conclusions:LILS technique could be successfully used to treat mild and severe pelvic organ prolapse with high objective and subjective cure rate as well as low complications.Short-term outcome and quality of sexual activity were significantly improved.Long-term outcome needs further.