腹腔镜阴道／子宫骶骨固定术治疗盆腔器官脱垂的疗效分析及术后性功能的评价

目的：探讨盆腔器官脱垂（POP）患者阴影子宫骶骨固定术的疗效及术后性功能的评价。方法：分析2008年1月至2013年12月对武汉大学人民医院经盆腔器官脱垂定量分度法（POP-Q）分度证实为Ⅲ度及以上POP、且已完成生育的62例患者，28例行腹腔镜阴道骶骨固定术（HY＋CSP子宫切除），34例行子宫骶骨固定术（HSP子宫保留），分别在术后1、6、12个月以及此后每年1次随诊，应用POP-Q评估、尿失禁影响P-I卷（IIQ-7）、泌尿生殖系影响量表（UDI-6）、视觉模拟满意度评分法（vAs）评估患者术后疗效。采用女性性功能指标量表（FSFI）问卷调查，评估患者术前、术后1年性生活质量。结果：腹腔镜阴影子宫骶骨固定术后以POP-QII度为复发的客观标准，患者术前、术后进行POP-Q分度评估、UDI-6、IIQ-7问卷、VAS满意度评分比较有统计学意义（P〈0．05）。子宫骶骨固定术及阴道骶骨固定术患者术前FSn中位数得分相似，而手术前后FSFI评分差异有统计学意义（P〈0．05），且术后子宫骶骨固定组的性欲望、性兴奋和性高潮程度中位数得分明显高于阴道骶骨固定组。结论：阴妙子宫骶骨固定术是治疗盆腔器官脱垂疗效良好的手术方式之一，子宫骶骨固定术的子宫保留与患者术后性生活质量密切相关。

The curative effect and postoperative sexual function of sacrocolpopexy colposacropexy/sacrocopopexy hys- terocolposacropexy after repair of pelvic organ prolapse

Objectives： To evaluate the curative effect and postoperative sexual function of sacrocolpopexy eolposaeropexy/sacrocopopexy hysterocolposacropexy after repair of pelvic organ prolapse （POP）. Methods： The clinical profiles of 62 women with severe POP who had already given birth and underwent sacrocolpopexy colposaero- pexy （HY ＋ CSY） and sacrocolpopexy hysterocoposacropexy （HSP） between January 2008 and Dcember 2013 were retrospectively analyzed. All patients were defined as Pelvic Organ Prolapse Quantification （POP - Q） stage III. Follow - up was conducted at 1,6, and 12 months, and then annually. All patients completed the Female Sexual Function Index （FSFI） questionnaire, before and after surgery, completed the Urogenital Distresslnventory short form （UDI -6） and Incontinence Impact on Quality of Life short form （IIQ -7 ） questionnaires, and the satisfaction Visual Analogue Scale （VAS）. The end -point was postoperative sexual function as evaluated by the FSFI, clinical outcomes as evaluated by the POP - Q, UDI - 6, IIQ - 7 and VAS. Results： Sixty - two patients were included and underwent 34 HSP and 28 HY ＋ CSY. Based on stage II of POP - Q as recurrence criteria, the anatomical success and patient satisfaction rates were significantly higher after surgery （ P 〈 0.05 ）. Median pre - operative FSFI scores of the two groups were similar. Both groups （ HSP and HY ＋ CSP） were significantly improved after surgery （ P 〈 0. 05 ） in total score. Furthermore, median post - operative scores of the desire, arousal and orgasm domains showed a significant improvement in the HSP group compared with the HY ＋ CSY group. Conclusions ： Sacrocolpopexy col- posacropexy/sacrocopopexy hysteroeolposacropexy conferring satisfying long - term anatomic outcomes and uterus preservation is associated with greater improvement in sexual function.