腹腔镜下骶骨阴道固定术治疗女性盆腔脏器中重度脱垂21例

目的 探讨Y型聚丙烯网片腹腔镜下骶骨阴道固定术(LSC)治疗女性盆腔脏器脱垂(POP)的临床疗效及并发症。方法 选取2014年3月至2017年3月安徽省妇幼保健院收治的中重度POP病人21例,均采用Y型聚丙烯网片LSC术治疗,比较手术前后客观治愈率(POP-Q评分量表)、主观治愈率盆底功能障碍性疾病症状问卷(PFDI-20)、盆底疾病生活质量影响问卷短表(PRIQ-7)、性生活质量问卷(PISQ-12)]及并发症情况。结果 21例病人客观治愈率100.0%,主观治愈率90.5%。POP-Q 分期中C、Aa、Ap、Ba、Bp点值术后明显减小；PFDI-20评分、PFIQ-7 评分术后明显减小,PISQ-12 评分术后明显增加,整体差异及各时点与术前比较,均差异有统计学意义(P＜0.01)。术后随访1年未见POP 复发、补片侵蚀、肠梗阻等并发症。3 例术后新发轻度压力性尿失禁(SUI),1KG-*3]～3月后逐渐消失。结论 采用Y型聚丙烯网片LSC术治疗中重度POP的主、客观治愈率高,阴道顶端脱垂的复发率极低,术后对病人生活质量影响少,不仅可纠正中盆腔缺陷,同时也可纠正重度膀胱膨出或直肠膨出。LSC术的长期疗效仍待观察。

Laparoscopic sacral vaginopexy for the treatment of moderate to severe pelvic organ prolapse in 21 women

Objective To investigate the clinical efficacy and complications of laparoscopic sacrovaginopexy (LSC) in the treatment of female pelvic organs with moderate prolapse (POP).Methods Twenty-one cases of moderate to severe POP patients admitted to Anhui Provincial Maternal and Child Health Hospital from March 2014 to March 2017 were selected and treated with Y-type polypropylene mesh LSC.Objective cure rate (POP-Q score scale),subjective cure rate pelvic floor dysfunction symptom questionnaire (PFDI-20),pelvic floor disease quality of life impact questionnaire (PRIQ-7),sexual life quality questionnaire (PISQ-12)] and complications were compared before and after surgery.Results For 21 patients,the objective cure rate was 100.0% and the subjective cure rate was 90.5%.The point values of C,Aa,Ap,Ba and Bp in the POP-Q stage were all decreased significantly after surgery.After surgery,PFDI-20 and PFIQ-7 score were decreased significantly,and PISQ-12 score was increased significantly.The overall difference and time points were statistically significant compared with those before operation (P<0.01).No recurrence of POP,mesh erosion,intestinal obstruction and other complications were found in 1 year postoperative follow-up.Three patients newly developed mild stress urinary incontinence (SUI) after surgery,which gradually disappeared after 1-3 months.Conclusion The Y-polypropylene mesh LSC has a high subjective and objective cure rate for the treatment of moderate and severe POP,low recurrence rate of vaginal top prolapseandpostoperative impact on the patient''s quality of life.It can correct the pelvic cavity defects,but alsosevere cystocele or rectocele.The long-term efficacy of LSC surgery.