经阴道手术治疗盆底功能障碍性疾病108例临床分析

目的:探讨保留子宫的盆底悬吊术治疗盆底障碍性疾病(PFD)的临床应用价值。方法:回顾性分析2008年2月～2011年7月我院收治的108例PFD患者的临床资料。A组行保留子宫的盆底悬吊术19例;B组行阴式子宫切除(TVH)+盆底悬吊术26例;两组中合并压力性尿失禁者同时实施经闭孔无张力尿道中段悬吊术(TVT-O);C组行传统TVH+阴道前后壁修补术63例。比较3组术中情况及术后疗效。结果:A组术中出血少、胃肠功能恢复快、手术时间、保留导尿时间、住院时间短,与其他两组比较差异均有统计学意义(P<0.05);3组均无严重并发症发生;术后中位随访时间为11个月,108例患者子宫脱垂、阴道前后壁脱垂等症状基本改善。A、B、C组复发率分别为5.26%、3.85%、14.29%。结论:保留子宫的盆底重建术治疗PFD手术时间短、出血少、疗效好,其复发率低,近期疗效稳定,长期疗效有待进一步观察。

Transvaginal surgery for pelvic floor dysfunction disease: Report of 108 cases

Objective: To investigate the clinical effect of the pelvic floor reconstruction with preservation of the uterus in treatment of pelvic floor dysfunction(PFD).Methods: The clinical data were retrospectively analyzed in 108 patients undergone treatment of PFD in our hospital between Feb.2008 and Jul.2011.Group A received pelvic floor reconstruction with preservation of the uterus(n=19),group B underwent transvaginal hysterectomy(TVH) plus pelvic floor reconstruction with uterus preserved(n=26)(those complicated with stress urinary incontinence in the two groups being given treatment of TVT obturator or TVT-O),and group C were treated by combined conventional TVH with colporrhaphia anterior-posterior(n=63).The three groups were compared regarding the intraoperative conditions and curative effect.Results:Group A had less intraoperative bleeding,earlier recovery of gastrointestinal function,shorter duration of the procedure,shortened retention of urethral catheter and hospital stay as compared with other two groups(P<0.05).No serious complications occurred in the three groups.A median follow-up of 11 months suggested that the total 108 patients were greatly improved in pelvic organ prolapse,and the relapse was 5.26%,3.85% and 14.29% for group A,B and C,respectively.Conclusion:Pelvic floor reconstruction with preservation of uterus appears effective for PFD,with shorter procedure time,less blood loss,fewer recurrences and stable middle and short-term curative effect,yet,the long-term effect needs to be further investigated.