阴式子宫切除术加阴道部分封闭术治疗老年盆腔器官脱垂的疗效和生活质量评价

目的评价阴式子宫切除加阴道部分封闭术对无性生活要求的老年盆腔器官脱垂患者手术效果和生活质量的影响。方法2007年12月至2009年4月对北京大学第三医院妇产科20例无性生活要求的POP-Q分期Ⅲ～Ⅳ期的老年盆腔脏器脱垂患者进行阴式子宫切除+阴道部分封闭术,1例保留子宫行阴道部分封闭术。采用PFDI-20短表调查患者生活质量。结果21例患者均有Ⅲ～Ⅳ期前盆腔缺陷,16例(76.19%)Ⅲ～Ⅳ期中盆腔缺陷,4例(19.05%)Ⅲ～Ⅳ期后盆腔缺陷。平均手术时间(146.95±60.83)min,平均术中出血量(65.71±39.32)ml,术中无并发症发生。3例围手术期并发症。21例患者均完成随访,平均随访时间(11.14±5.28)个月。主观和客观治愈率均为100%。术前PFDI-20总评分为(76.82±36.46)分,术后下降为(8.87±15.33)分。术前3个分量表POPDI-6、CARDI-8和UDI-6评分分别为(38±17)分、(1.25±1.5)分、(37.5±25)分,术后分别降为(2±4)分、(0.25±0.5)分、(6.5±11.75)分。术前术后评分比较,差异均有统计学意义(P0.05)。结论对于无性生活要求的老年盆腔器官脱垂患者,采用阴式子宫切除加阴道部分封闭术,疗效肯定,可改善患者术后近期的生活质量。

Short term effect of transvaginal hysterectomy and Le Fort partial colpocleisis in elderly woman with pelvic organ prolapse

Objective To evaluate the effect of transvaginal hysterectonmy and Le Fort partial colpocleisis on patients＇ quality of life （QOL）.Methods 21 Women with pelvic organ prolapse （POPQ stage Ⅲ～ Ⅳ） who underwent Le Fort partial colpocleisis,20 cases with concomitant hysterectomy in our department from December,2007 to April,2009 were studied retrospectively. QOL was evaluated using short form 20 （PFDI-20）. Results The mean age was 70.1 years old （60~82 years old）. The preoperative diagnosis by POP-Q were：stage Ⅲ and Ⅳ anterior compartment defect,21 cases （100%）; stage Ⅲ and Ⅳ middle compartment defect,16 cases（76.19%）;posterior compartment defect,4 cases（19.05%）. The mean operative time was （46.95±60.83）min.The mean blood loss was（65.71±39.32）ml. There was no intraoperative complications ocurred.3 cases perioperative period was cocurred.All patients were under follow-up,the mean follow-up time was（11.14±5.28）m（6~21 monthes）. Both the objective and subjective cure rate were 100%. Before operation,the PFDI-20 score,POPDI-6 （pelvic organ prolapse distress inventory ）,CARDI-8 （colorectal anal distress inventory 8） and UDI-6 （ urinary distress inventory 6） scores were 76.82±36.46,38±17,1.25±1.5 and 37.5±25,respectively,which were 8.87±15.33,2±4,0.25±0.5 and 6.5±11.75 respectively after surgery（P0.05）.Conclusions Transvaginal hysterectomy and Le Fort partial colpocleisis is a feasible option for elderly patients with severe vaginal prolapse. It can improve the short term quality of life for these patients.