摘要
目的 评估阴式腹膜外高位宫骶韧带悬吊术(EHUS)治疗中盆腔缺陷的临床疗效.方法 回顾性分析 2020 年 7 月 1 日至 2022 年 7 月 31 日在银川市第一人民医院因中盆腔器官脱垂≥Ⅱ度行手术治疗的患者资料,符合入组条件且随访资料齐全的患者共 85 例,其中绝经前患者 27 例,21 例行EHUS术定义为EHUS组 1,6 例行前盆重建术定义为前盆组 1;绝经后患者 58 例,24 例行EHUS术定义为EHUS组 2,34例行前盆重建术定义为前盆组 2.比较各组一般资料、围术期相关指标、盆腔器官脱垂定量系统(POP-Q)各指示点(Aa、Ba、C、Ap、Bp)、盆底功能障碍问卷简表(PFDI-20)、性功能问卷(PISQ-12)及术后并发症.结果 EHUS组 2 与前盆组 2 患者手术时间及术后住院时间比较,差异均无统计学意义(P均＞0.05);术后留置尿管时间及术中出血量EHUS组 2 均高于前盆组 2(P均＜0.05).EHUS组 1、EHUS组 2、前盆组 1 和前盆组 2 患者术后 1 年POP-Q各点均较术前减小(P均＜0.05);各组PFDI-20 评分较术前降低(P均＜0.05),而PISQ-12 评分较术前升高(P均＜0.05).EHUS组 1 与EHUS组 2 患者术后 1 年POP-Q分度中各指示点、PFDI-20 评分、PISQ-12 评分比较差异均无统计学意义(P均＞0.05).EHUS组 2 与前盆组 2 患者术后 1 年POP-Q分度中各指示点、PISQ-12 评分比较差异均无统计学意义(P均＞0.05);在生活质量PFDI-20 评分中,EHUS组 2 的评分较前盆组 2 低(P＜0.05).EHUS组 1 及EHUS组 2 患者未出现输尿管梗阻、脱垂复发、性生活不适等并发症.前盆组 2 发现网片暴露 1 例,该患者同时合并阴道壁溃疡及新发性交痛,并发症发生率为 2.5%.结论 EHUS在治疗中盆腔缺陷方面疗效可以达到使用网片的前盆腔重建术的效果,可有效治疗中盆腔器官脱垂.
Abstract
Objective To evaluate the clinical efficacy of vaginal extraperitoneal high uterosacral suspension surgery(EHUS)for the treatment of middle pelvic cavity defect.Methods A retrospective case-control study was conducted to collect 85 patients with pelvic organ prolapse≥Ⅱdegrees who underwent surgical treatment at the First People's Hospital of Yinchuan City from July 1,2020 to July 31,2022.Through retrospective research analysis,among them,there were 27 premenopausal patients,21 cases of EHUS surgery were defined as EHUS group 1,and 6 cases of anterior pelvic reconstruction surgery and were defined as anterior pelvic group 1.There were 58 postmenopausal patients,of which 24 underwent EHUS surgery were defined as EHUS group 2,and 34 underwent anterior pelvic reconstruction surgery were defined as anterior pelvic group 2.The general information,perioperative related indicators,POP-Q indicators(Aa,Ba,C,Ap,Bp),pelvic floor dysfunction disease related questionnaire(PFDI-20),pelvic floor organ prolapse on sexual function questionnaire(PISQ-12),and postoperative complications among each group were compared.Results There was no statistically significant difference in surgical time and postoperative hospital stay between EHUS group 2 and anterior pelvic group 2 patients(P all＞0.05).The postoperative indwelling catheter time and intraoperative blood loss in EHUS group 2 were higher than in anterior pelvic group 2(P all＜0.05).EHUS Group 1,EHUS Group 2,Anterior Pelvic Group 1,and Anterior Pelvic Group 2 all showed a decrease in POP-Q at 1 year post surgery compared to preoperative levels(P all＜0.05);The PFDI-20 score in each group decreased compared to preoperative levels(P all＜0.05),while the PISQ-12 score increased compared to preoperative levels(P all＜0.05).There were no statistically significant differences in the POP-Q scores,PFDI-20 scores,and PISQ-12 scores between EHUS group 1 and EHUS group 2 at 1 year after surgery(P all＞0.05).There were no statistically significant differences in the POP-Q scores and PISQ-12 scores between EHUS group 2 and anterior pelvic group 2 patients after 1 year of surgery(P all＞0.05).In the PFDI-20 score of quality of life,the score of EHUS group 2 was lower than that of anterior pelvic group 2(P＜0.05).Patients in EHUS group 1 and EHUS group 2 did not experience complications such as ureteral obstruction,recurrent prolapse,or sexual discomfort.The anterior pelvic reconstruction group showed 1 case of mesh exposure,which was accompanied by vaginal wall ulcers and new onset of pain during intercourse.The incidence of complications was 2.5%.Conclusion EHUS surgery has the same therapeutic effect in treating pelvic defects as traditional anterior pelvic reconstruction surgery using mesh,which can effectively treat pelvic organ prolapse.
基金项目
宁夏卫生健康委科研项目(2022-NWKY-083)
维普
万方数据