保留子宫Prolift全盆底重建术与传统手术治疗重度盆腔器官脱垂疗效比较

目的比较保留子宫的Prolift全盆底重建术与传统手术(阴式子宫切除+阴道前后壁修补)在治疗女性重度盆腔器官脱垂中的临床疗效。方法对2008年7月至2011年9月中山大学附属第一医院31例盆腔器官脱垂定量分度法(POP-Q)Ⅲ度和Ⅳ度的盆腔器官脱垂患者施行保留子宫的Prolift全盆底重建术(重建组),与同期43例施行传统手术治疗(阴式子宫切除+阴道前后壁修补)(传统组)的病例进行比较。通过POP-Q评价解剖恢复疗效,盆底功能障碍影响简易问卷(PFIQ-7)评价功能恢复疗效,同时分析性生活及术中术后并发症等情况。结果两组平均手术时间、术中出血、术后住院天数比较差异均无统计学意义(P>0.05);重建组尿管留置时间短于传统组(P<0.05)。两组术后POP-Q分度各指示点、PFIQ-7评分均较术前改善(P<0.05),术后总阴道长度(TVL)重建组大于传统组(P<0.05),其他指标两组间比较差异无统计学意义(P>0.05)。解剖治愈率重建组96.77%(30/31)高于传统组79.07%(34/43)(P<0.05)。重建组患者主观满意度95.74%,传统组95.37%,差异无统计学意义(P>0.05)。两组术中均未出现严重并发症,但重建组7例,传统组6例,术后发生压力性尿失禁。重建组术后出现性交痛例数比(2/3)大于传统组(1/6)。结论保留子宫的Prolift全盆底重建术有更好的解剖恢复疗效,但盆底功能恢复和患者主观满意度方面与传统手术治疗比较差异无统计学意义。盆底修复手术术前应仔细评估尿控情况,防止术后出现排尿异常。对性生活较活跃患者,采用Prolift全盆底重建术时应慎重。

Clinical analysis of uterus-retained total pelvic floor reconstruction and routine trans-vaginal surgery in the treatment of pelvic organ prolapse.

Objective To evaluate the clinical effectiveness of uterus-retained total pelvic floor reconstruction and routine trans-vaginal surgery in the treatment of severe pelvic organ prolapse.Methods We retrospectively analyzed the clinical data of 74 patients with pelvic organ prolapse(stage Ⅲ and stage Ⅳ) between July 2008 and September 2011.31 cases received uterus-retained total pelvic floor reconstruction(reconstruction group) and 43 cases received routine surgery(routine group).The anatomical outcomes were evaluated by POP-Q,functional effectiveness by PFIQ-7,and operation related complications were also analyzed.Results The anatomical cure rate of the reconstruction group(30/31) was bigger than the routine group(34/43)(P<0.05).The post-operative quality of life was improved significantly in both two groups but there was no significant difference between the two groups.The patient subjective satisfaction was 95.74% in the reconstruction group while 95.37% in the routine group,there was no significant difference(P>0.05).There were no serious complications in the two groups in-surgery.But 7/31 in the reconstruction group and 6/43 in the traditional group suffered from stress urinary incontinence.2 of 3 in the reconstruction group and 1 of 6 in the traditional group suffered from dyspareunia.Conclusion Uterus-retained total pelvic floor reconstruction can repair defects and recover pelvic structure better,But there was no significant difference between the two groups when related to the functional effectiveness and the satisfaction of the patients.Urinary incontinence should be evaluated carefully in case the urinary problems.The reconstruction surgery should be evaluated carefully when took on the sexually active women.