61例盆腔器官脱垂两种手术方法疗效观察

目的:评价全盆底重建术、骶棘韧带悬吊术两种不同的手术方式对盆腔器官脱垂的临床效果。方法:对复旦大学附属妇产科医院和宁波市第七医院采取全盆底重建术(A组42例)、骶棘韧带悬吊术(B组19例)的61例盆腔器官脱垂患者进行回顾性分析,对两组术中情况和术后疗效进行比较。结果:两组无膀胱、直肠损伤,无大血管、神经损伤等并发症发生,A组发生网片侵蚀1例。两组在术中出血、手术时间、术后留置导尿日、膀胱残余尿量、术后正常活动时间、术后体温平稳时间等临床资料方面差异无统计学意义(P>0.05);而在住院费用方面,B组明显优于A组(P<0.01)。术后随访,A组盆腔器官脱垂1例复发,B组无盆腔器官脱垂复发病例。B组阴道长度大于全盆底重建组(P<0.01),最后一次随访时盆底功能影响问卷(PFIQ-7)评分A组高于B组(P<0.05)。结论:两者均为治疗重度POP有效、安全的方法。全盆底重建术后新发尿失禁、尿潴留不容忽视,骶棘韧带悬吊术医疗费用低、加深阴道长度、无异物侵蚀、对生活质量影响少,但远期效果有待进一步观察。

Observation on curative effects of two surgical methods for treatment of 61 cases with pelvic organ prolapse

Objective:To evaluate the clinical outcomes of total pelvic floor reconstruction and sacrospinous ligament suspension surgery for pelvic organ prolapse(POP).Methods:Sixty-one POP cases were retrospectively divided into two groups from 2 hospitals.The degree of POP before operation,surgerical procedure,and post-operation effectiveness were compared between group A(total pelvic floor reconstruction) and group B(sacrospinous ligament suspension surgery).Results:The cases in the two groups had no complication except one case with mesh erosion in group A.Before operation,there was no statistical significant difference in age,parity,surgery,POP-Q degree between the two groups(P>0.05);there was no statistical significant difference in bleeding,surgery time,duration of urinary catheter placement,residual urine volume,postoperative ambulation day,temperature stability,antibiotics utility,and length of stay between the two groups(P>0.05).However,there was statistically significant difference in hospitalization fee between the two groups(P<0.01).No case was recurrent in group B compared to one case in group A after operation.The length of vagina in group B was statistically significantly longer than that in group A(P<0.05).The scores of pelvic floor incontinence questionnaire during the final follow-up in group A were statistically significantly higher than those in group B(P<0.05).Conclusion:Both total pelvic floor reconstruction and mesh implantation and sacrospinous ligament suspension surgery are effective and safe in treating severe POP.However,sacrospinous ligament suspension is prior because of its low medical cost,longer vaginal length,lower risk of mesh erosion,and higher life quality.