腹腔镜下侧腹壁悬吊术治疗老年女性前中盆腔器官脱垂的疗效分析

Analysis of therapeutic effect of laparoscopic lateral suspension in treatment of anterior and apical pelvic organ prolapse in eld-erly women

中文关键词: 老年  女性  盆腔器官脱垂  腹腔镜下侧腹壁悬吊术  网片  经阴道全子宫切除术  阴道前后壁壁修补术

英文关键词: elderly  woman  pelvic organ prolapse  laparoscopic lateral suspension  mesh  trans vaginal hysterectomy  anterior and posterior colporrhaphy

中文摘要:

      目的 探讨腹腔镜下侧腹壁悬吊术治疗老年女性前中盆腔器官脱垂的有效性和安全性.方法 选择2022年5月—2023年12月复旦大学附属华东医院收治的盆腔器官脱垂Ⅱ～Ⅳ度的患者60例为研究对象,根据不同手术方法将其分为观察组(30例)和对照组(30例).观察组采用腹腔镜下侧腹壁悬吊术或联合阴道后壁修补术,对照组采用传统经阴道全子宫切除联合阴道前后壁修补术.比较2组一般资料(年龄、孕产次、体质量指数)、手术相关指标值(手术时间、术中出血量、留置导尿时间及术后住院时间等)、术前及术后12个月POP-Q各指示点量化值的变化来评价其客观疗效、术前及术后12个月盆底不适调查简表(PFDI-20)、盆腔器官脱垂及尿失禁性生活问卷(PISQ-12)评价其主观疗效.比较2组1年客观治愈率及复发率、围手术期并发症发生情况.结果 观察组术中出血量、术后留置导尿时间和术后住院时间少于对照组,观察组手术时间大于对照组,差异有统计学意义(P＜0.05).2组术后12个月POP-Q各指示点量化值较术前均有明显改善,但观察组术后C点量化值较对照组改善更为明显,差异有统计学意义(P＜0.05).2组术后12个月PFDI-20 及PISQ-12问卷评分较术前明显改善,但观察组术后性生活改善更为明显,差异有统计学意义(P＜0.05).2组1年客观治愈率、复发率及并发症比较差异无统计学意义(P＞0.05).结论 与传统术式相比,腹腔镜下侧腹壁悬吊术用于老年女性前中盆腔器官脱垂的治疗,安全有效.

英文摘要:

      Objective To investigate the efficacy and safety of laparoscopic lateral suspension(LLS)in the treatment of anterior and apical pelvic organ prolapse(POP)in elderly women.Methods 60 patients with stage Ⅱ～Ⅳ POP admitted to Huadong Hospital Affiliated to Fudan University between May 2022 and December 2023 were enrolled.They were divided into observation group(30 cases)and control group(30 cases)according to different surgical methods.The observation group underwent LLS or combined with posterior colporrhaphy,while the control group did traditional transvaginal hysterectomy com-bined with anterior and posterior colporrhaphy.The general data[age,pregnancy and childbirth times,body mass index(BMI)]and surgical indicators(operative time,intraoperative blood loss,catheter indwelling time,postoperative hospital stay)were compared between the two groups.The objective therapeutic effect was evaluated by the changes in the quantitative values of each indicator point of POP-Q before the operation and 12 months after the operation.The subjective therapeutic effect was evaluated by Pelvic Floor Distress Inventory Short Form 20(PFDI-20)and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ-12)before the operation and 12 months after the operation.The one-year objective cure rate and re-currence rate,as well as the occurrence of perioperative complications,were compared between the two groups.Results The observation group had significantly less intraoperative blood loss,shorter catheter indwelling time,and shorter postoperative hospital stay than the control group,but longer operative time(P＜0.05).The quantitative values of each indicator point of POP-Q in both groups 12 months after the operation were significantly improved compared with those before the operation.However,the quantitative value of indicator point C in the observation group improved more significantly than that in the con-trol group after the operation,and the difference was statistically significant(P＜0.05).The questionnaire scores of PFDI-20 and PISQ-12 in both groups at 12 months after the operation were significantly improved compared with those before the opera-tion.However,the improvement of sexual life in the observation group after the operation was more obvious,and the differ-ence was statistically significant(P＜0.05).There was no statistically significant difference in the one-year objective cure rate,recurrence rate and incidence of postoperative complications between the two groups(P＞0.05).Conclusion Compared with traditional surgery,LLS is safe and effective for the treatment of anterior and apical POP in elderly women.