摘要
目的探讨一个切口两个隧道脱垂子宫腹直肌悬吊固定术在子宫脱垂患者中的应用价值。方法2018年1-12月青海大学附属医院妇科从青海各州县选取子宫脱垂且盆腔器官脱垂量化(POP-Q)分期重Ⅰ度伴阴道前后壁脱垂、Ⅱ度及以上的患者70例为研究对象。按照随机数字表法将其分为对照组(n=30)和观察组(n=40),其中对照组患者给予自裁Gynemesh网片穿刺行改良盆底重建术治疗,观察组患者给予腔镜下一个切口两个隧道脱垂子宫腹直肌悬吊固定术治疗。比较2组患者围术期指标、生活质量(QOL量表)、性生活质量(PISQ-12量表)评分、术后盆底功能障碍(PFIQ-7、PFDI-20量表)以及POP-Q指标变化,观察2组患者术后并发症以及术后复发情况。结果观察组患者的手术时间、术中出血量、留置尿管时间、平均住院时间以及肛门排气时间均明显低于对照组,差异具有统计学意义(P<0.01)。与治疗前相比,2组患者治疗后PFIQ-7、PFDI-20评分均明显降低,QOL、PISQ-12评分均明显升高,且观察组患者上述指标改善较对照组更为显著(t/P=11.882/<0.001、7.685/<0.001、3.682/0.000、5.424/<0.001);2组患者治疗后POP-Q各项指标除Ba指标外均显著改善,而2组间比较差异无统计学意义(P>0.05)。观察组术后并发症发生情况以及术后复发率均明显低于对照组,差异具有统计学意义(χ^2/P=11.672/0.001、4.887/0.027)。结论腔镜下一个切口两个隧道脱垂子宫腹直肌悬吊固定术并发症少、创伤小、术后恢复快,复发率低,患者易于接受,具有较好的临床应用价值。
Objective To explore the application value of suspension and fixation of rectus abdominis with one incision and two tunnels in patients with uterine prolapse.Methods From January to December 2018,the Department of Gynecology of the Affiliated Hospital of Qinghai University selected 70 patients with uterine prolapse and pelvic organ prolapse(POP Q)in stages of severe degree I with vaginal anterior and posterior wall prolapse,degree II and above as subjects.The patients in the control group were treated with modified pelvic floor reconstruction with self-tailored Gynemesh puncture and the patients in the observation group were treated with suspension fixation of rectus abdominis with two tunnels prolapsed under endoscopy.The perioperative indicators,quality of life(QOL scale),quality of sexual life(PISQ 12 scale),pelvic floor dysfunction(PFIQ 7,PFDI 20 scale)and POP Q were compared between the two groups.The postoperative complications and recurrence of the two groups were observed.Results The operation time,intraoperative blood loss,indwelling catheter time,average hospital stay and anal exhaust time were significantly lower in the observation group than in the control group,and the difference was statistically significant(P<0.01).Compared with before treatment,the PFIQ 7 and PFDI 20 scores of the two groups were significantly decreased after treatment,and the QOL and PISQ 12 scores were significantly increased,and the improvement of the above indicators was more significant in the observation group than in the control group(t/P=11.882/<0.001,t/P=7.685/<0.001,t/P=3.682/0.000,t/P=5.424/<0.001);the POP Q indexes of the two groups of patients were significantly improved except for the Ba index after treatment.There was no significant difference between the two groups(P>0.05).The postoperative complications and postoperative recurrence rate in the observation group were significantly lower than those in the control group,and the difference was statistically significant(χ^2/P=11.672/0.001,χ^2/P=4.887/0.027).Conclusio
作者
王海燕
马生秀
穆庆芬
刘哲
郑惠木
张路
WANG Haiyan;MA Shengxiu;MU Qingfen;LIU Zhe;ZHENG Huimu;ZHANG Lu(Department of Gynecology,Affiliated Hospital of Qinghai University,Xining 810001,China)
出处
《疑难病杂志》
CAS
2019年第7期705-709,共5页
Chinese Journal of Difficult and Complicated Cases
基金
青海省卫生系统指导性计划课题(2018-wjzdx-103)
关键词
子宫脱垂
腹直肌悬吊固定术
一个切口两个隧道
腔镜下
Uterine prolapse
Rectus abdominis suspension fixation
One incision two tunnels
Endoscopic rectus abdominis suspension fixation
