非脱垂阴式子宫切除盆底改良重建术的应用探讨

目的探讨非脱垂阴式子宫切除中盆底改良重建术的临床应用价值。方法选择2007年1月～2008月3月在某院行非脱垂阴式子宫切除术80例,其中非脱垂阴式子宫切除术+盆底改良重建术40例(治疗组),单纯非脱垂阴式子宫切除术40例(对照组),比较两组手术主要指标和术后患者对性生活满意度及术后阴道顶端脱垂等并发症情况。结果治疗组术后阴道残端脱垂第1年Ⅰ度2例,占5.00%、第2年、第3年Ⅰ度均为3例,占7.50%,对照组第1年Ⅰ度9例,占22.50%;第2年Ⅰ度11例,占27.50%;第3年Ⅰ度14例,占35.00%、Ⅱ度3例,占7.50%,两组差异有统计学意义(χ2=15.179,P﹤0.01);治疗组术后3年内阴道顶端脱垂发生率无明显改变,差异无统计学意义(P﹥0.05),对照组术后第3年阴道顶端脱垂Ⅰ度、Ⅱ度共17例,占42.50%,与术后第1年相比差异有统计学意义(χ2=6.444,P=0.040);术后6个月、12个月和24个月性生活满意度评分两组差异有统计学意义(P﹤0.05)。结论改良盆底重建术能实现盆底结构的重建和组织替代,保持术后盆底支持组织的完整性,预防术后阴道顶端脱垂,降低术后并发症,提高术后患者生活质量的作用。

Application of pelvic floor reconstruction for Non-prolapsed vaginal hysterectomy

OBJECTIVE To investigate the clinical application of pelvic floor improved reconstruction for prolapsed vaginal hysterectomy in clinics.METHODS From January 2007 to March 2008,a total of 80 cases with non-prolapsed vaginal hysterectomy were collected.40 patients with non-prolapsed vaginal hysterectomy received pelvic floor reconstruction(treatment group).40 patients received simple non-prolapsed vaginal hysterectomy(control group).The main indicators,sexual life satisfaction and postoperative complications such as vaginal prolapsed were compared.RESULTS In the first year,there were 2 cases with grade Ⅰvaginal stump prolapse of the treatment group,accounted for 5.00%.In the second 2 years and 3 years,there were respectively 3 cases of grade Ⅰ,accounted for 7.50%.In the first year of the control group,there were 9 cases of grade Ⅰ,and accounted for 22.50%;In the 2th years of grade Ⅰ,there were 11 cases,and accounted for 27.50%.In the 3th years,there were 14 cases of grade Ⅰ,and accounted for 35.00%.There were 3 cases of grade Ⅱ,and accounted for 7.50%.There was significant difference in grade I and grade II(χ2 = 15.179,P﹤0.01);After treatment group for 3 years,there was no significant difference in the incidence of vaginal prolapsed(P﹥0.05).In the control group after treatment for 3 years,there were 17 vaginal prolapse cases with grade Ⅰ and Ⅱ,and accounted for 42.50%,which was significantly better than the situation before treatment(χ2 = 6.444,P = 0.040);There was significant difference in the sexual satisfaction score at the time of 6 months,12-month and 36 months between the two groups(P﹤0.05).CONCLUSION The modified pelvic floor reconstruction as a new surgical technique,which can achieve the reconstruction of pelvic floor structure and tissue replacement,maintain the integrity of the postoperative top vaginal prolapse,reduce complications and improve quality of life of postoperation.