腹腔镜腹膜外网片子宫-腹壁筋膜固定联合阴道后壁非穿刺重建术治疗中重度POP临床研究

摘要

目的 探讨腹腔镜腹膜外网片子宫-腹壁筋膜固定联合阴道后壁非穿刺重建术治疗中重度盆腔器官脱垂(POP)临床疗效.方法 收集行腹腔镜腹膜外网片子宫-腹壁筋膜悬吊术治疗的41例中重度POP患者,根据患者意愿选择手术方法,其中行联合阴道后壁非穿刺重建术21例(改良组),行联合传统阴道壁修补术20例(传统组).比较2组患者的手术时间、术中出血量、住院时间及术后并发症,术后12个月测量患者 POP-Q各点数值以评价术后盆底功能改善状况,以盆底不适调查表短表20(PFDI-20)评价手术前后患者的生活质量.结果 41例患者均经腹腔镜成功完成手术,术中无发生膀胱、输尿管、直肠损伤等并发症.改良组的手术时间、术中出血量、住院时间与传统组比较差异均无统计学意义(P均>0.05).术后随访12个月,2组患者子宫和阴道前壁脱垂均无复发,改良组Aa、D、Ap和Bp点值均优于传统组(P均<0.05).改良组中有1例出现阴道网片暴露.术后2组患者的PFDI-20及各子量表得分均低于术前(P均<0.01),其中术后改良组的结直肠肛门困扰量表得分低于传统组(P<0.01).结论 腹腔镜腹膜外网片子宫-腹壁筋膜固定联合阴道后壁非穿刺重建术治疗中重度POP安全、有效,且具有操作简单、手术时间短、术中出血量少、术后并发症少等优点.%Objective To evaluate the clinical efficacy of laparoscopic extraperitoneal repair with mesh uterine-abdominal wall fascial fixation combined with non-puncture reconstruction of posterior vaginal wall in the treatment of middle or severe pelvic organ prolapse (POP).Methods Clinical data of 41 patients diagnosed with middle or severe POP undergoing laparoscopic extraperitoneal repair with mesh uterine-abdominal wall fascial suspension were retrospectively analyzed.Based upon the willingness of patients, 21 patients underwent laparoscopic extraperitoneal repair with mesh uterine-abdominal wall fascial fixation combined with non-puncture reconstruction of posterior vaginal wall in the modified group, and 20 cases received laparoscopic extraperitoneal repair with mesh uterine-abdominal wall fascial fixation in combination with traditional vaginal repair in the traditional group.The operation time, intraoperative hemorrhage volume, length of hospital stay and postoperative complications were statistically compared between two groups.At postoperative 12 months, POP-Q scores at each point were measured to evaluate the improvement of postoperative pelvic floor function.Preoperative and postoperative quality of life was assessed by the pelvic floor distress inventory-20 (PFDI-20).Results Forty-one patients successfully underwent laparoscopic surgery.Intraoperatively, postoperative complications, such as bladder, ureteral and rectal injury, did not occur.No statistical significance was identified in the operation time, intraoperative hemorrhage volume and length of hospital stay between two groups (all P>0.05).During 12-month follow-up, neither uterine nor anterior vaginal wall prolapse recurred in both groups.The POP-Q scores at Aa, D, Ap and Bp point in the modified group were significantly higher compared with those in the traditional group (all P<0.05).In the modified group, one patient presented with exposure of vaginal mesh.In both groups, postoperative scores of PFDI-20 and each subscale were significantly lower than those prior to surgery (all P<0.01).The score of colorectal-anal impact questionnaire (CRADI-8) in the modified group was considerably lower than that in the traditional group (P<0.01).Conclusions Laparoscopic extraperitoneal repair with mesh uterine-abdominal wall fascial fixation combined with non-puncture reconstruction of posterior vaginal wall is an efficacious and safe technique for the treatment of middle or severe POP, which is convenient to operate, requires short operation time and yields slight intraoperative hemorrhage volume and mild postoperative complications.