腹腔镜下侧腹壁悬吊术在中老年盆腔脏器脱垂中的应用效果

Application effects of laparoscopic lateral suspension in middle-aged and elderly patients with pelvic organ prolapse

中文关键词: 中老年  阴道前后壁修补术  盆腔  脏器脱垂  腹腔镜下侧腹壁悬吊术  阴式子宫切除  效果

英文关键词: middle-aged and elderly  anterior and posterior vaginal wall repair  pelvic cavity  organ prolapse  laparo-scopic lateral suspension  vaginal hysterectomy  effect

中文摘要:

      目的 探讨腹腔镜下侧腹壁悬吊术(LLS)在中老年盆腔脏器脱垂(POP)中的应用效果,为临床中老年POP的治疗提供依据.方法 回顾性分析2021年1月—2024年12月在复旦大学附属金山医院妇产科住院手术治疗的106例中老年POP患者的临床资料,根据手术治疗方法分为对照组(n=54)和观察组(n=52).对照组行阴式全子宫切除+阴道前后壁修补术,观察组行腹腔镜下不保留/保留子宫双附件术式+阴道顶端侧腹壁悬吊术.收集2组患者基本资料、围手术期各项指标值和术后并发症情况(排尿困难、排便不适、感染等).分别于术前及术后6个月,采用盆腔脏器脱垂定量评估系统量表(POP-Q)评估盆腔脏器解剖复位情况,采用盆底功能障碍问卷量表(PFDI-20)评估盆底功能恢复情况.结果 观察组患者术后排气时间[(23.00±5.51)h]短于对照组[(29.48±9.47)h],手术费用[(5 256.19±595.28)元]和住院费用[(45 488.92±3 165.16)元]高于对照组[(4 873.72±450.55)元、(17 007.17±2 598.44)元],术后并发症发生率(3.85％)低于对照组(16.67％),差异均具有统计学意义(t=4.287,3.739、50.719;x2=4.682;P＜0.05).术后 6 个月,观察组 POP-Q 指标[Aa 值(-2.80±0.32)cm、Ba 值(-2.73±0.85)cm、C值(-5.55±0.60)cm]和 PFDI-20 评分[POPDI-6(0.42±0.11)分、CRADI-8(2.08±0.95)分、UDI-6(1.17±0.43)分]均低于对照组[Aa 值(-2.44±0.80)cm、Ba值(-2.32±0.64)cm、C 值(-4.82±0.69)cm;POPDI-6(1.50±0.36)分、CRADI-8(2.65±1.03)分、UDI-6(2.17±0.84)分],差异均具有统计学意义(t=3.044、2.784、5.715;7.410、2.969、5.140;P＜0.05).2 组患者Aa 点差值绝对值[(3.58±1.50)vs(4.38±1.21)]、POPDI-6 差值绝对值[(8.91±2.65)vs(10.69±3.73)]和 CRA-DI-8 差值绝对值[(1.24±1.59)vs(1.83±1.35)]比较,差异有统计学意义(t=2.977、2.846、2.041,P＜0.05).结论 相较于传统的阴式子宫切除+阴道前后壁修补手术,LLS治疗中老年POP临床效果更佳,可促进术后快速恢复,降低术后并发症的发生率,明显改善患者的盆底功能,提高术后生活质量,但费用相对增加.

英文摘要:

      Objective To investigate the application effects of laparoscopic lateral suspension(LLS)in middle-aged and elderly patients with pelvic organ prolapse(POP),and provide evidence for the clinical treatment of POP.Methods A retro-spective analysis was conducted on the clinical data of 106 middle-aged and elderly POP patients who underwent surgical treatment in Department of Gynecology and Obstetrics of Jinshan Hospital,Fudan University,between January 2021 and December 2024.According to the surgical method,they were divided into control group(n=54)and observation group(n=52).The control group underwent vaginal hysterectomy combined with anterior and posterior vaginal wall repair,while the observation group un-derwent laparoscopic bilateral adnexectomy(with or without uterine preservation)plus vaginal apex lateral suspension.The basic information,perioperative indicators,and postoperative complications(such as dysuria,bowel discomfort,and infection)were collected.Before surgery and 6 months after surgery,the Pelvic Organ Prolapse Quantification(POP-Q)system was used to e-valuate pelvic organ anatomical restoration,and the Pelvic Floor Distress Inventory-20(PFDI-20)was used to assess pelvic floor function recovery.Results The postoperative exhaust time in the observation group[(23.00±5.51)h]was shorter than that in the control group[(29.48±9.47)h](t=4.287,P＜0.05),the surgical cost[(5 256.19±595.28)yuan]and hospitalization cost[(45 488.92±3 165.16)yuan]were higher than those in the control group[(4 873.72±450.55)yuan,(17 007.17±2 598.44)yuan](t=3.739,50.719;P＜0.05),and the incidence of postoperative complications(3.85％)was lower than that in the control group(16.67％)(x2=4.682,P＜0.05).6 months after the operation,the POP-Q indica-tors[Aa value(-2.80±0.32)cm,Ba value(-2.73±0.85)cm,C value(-5.55±0.60)cm]and PFDI-20 scores[POPDI-6(0.42±0.11),CRADI-8(2.08±0.95),UDI-6(1.17±0.43)]in the observation group were lower than those in the control group[Aa value(-2.44±0.80)cm,Ba value(-2.32±0.64)cm,C value(-4.82±0.69)cm;POPDI-6(1.50±0.36),CRADI-8(2.65±1.03),UDI-6(2.17±0.84)],with statistically significant differences(t=3.044,2.784,5.715;7.410,2.969,5.140;P＜0.05).The absolute differences in Aa value[(3.58±1.50)vs(4.38±1.21)],POPDI-6 scores[(8.91±2.65)vs(10.69±3.73)],and CRADI-8 scores[(1.24±1.59)vs(1.83±1.35)]between the two groups were statistically significant(t=2.977,2.846,2.041;P＜0.05).Conclusion Compared with traditional vaginal hysterectomy combined with anterior and posterior vaginal wall repair,LLS demonstrates better clinical outcomes in the treat-ment of middle-aged and elderly POP patients.It promotes faster postoperative recovery,reduces the incidence of postoperative complications,significantly improves pelvic floor function,and enhances postoperative quality of life,but its cost is relatively high.