阴道前后壁修补联合腹腔镜髂耻韧带悬吊术与联合传统阴式子宫切除术的疗效比较

Comparison of the efficacy of anterior and posterior vaginal wall repair combined with laparoscopic iliopectineal ligament suspension or conventional transvaginal hysterectomy

摘要:

目的 比较阴道前后壁修补联合腹腔镜髂耻韧带悬吊术与联合传统阴式子宫切除术治疗盆腔器官脱垂（POP）的疗效。方法 选取2020年2月—2021年10月在泰州市人民医院就诊的82例POP患者，按随机数字表法分成研究组和对照组，每组41例。对照组行阴道前后壁修补联合传统阴式子宫切除术，研究组行阴道前后壁修补联合腹腔镜髂耻韧带悬吊术。两组均于术后6个月评估疗效。对比两组手术相关指标、盆底功能解剖学参数、盆底功能、性生活质量及并发症情况。术后12个月，记录两组客观治愈率与复发率。结果 研究组术中出血量少于对照组（P <0.05），术后阴道长度长于对照组（P <0.05），术后住院时间和手术时间短于对照组（P <0.05）。研究组手术前后的阴道前壁脱出距离处女膜最远处、阴道后壁脱出距离处女膜最远处、阴道前壁中线距处女膜3 cm处、子宫切除或宫颈最远端切除后阴道残端、阴道后壁中线距处女膜3 cm处的差值均低于对照组（P <0.05）。研究组手术前后盆底功能障碍影响问卷、盆底疾病生活质量影响问卷短表评分的差值均高于对照组（P <0.05）。研究组手术前后盆腔脏器脱垂/尿失禁性功能问卷、女性性功能评分量表评分的差值均高于对照组（P <0.05）。研究组并发症总发生率低于对照组（P <0.05）。研究组客观治愈率高于对照组（P <0.05），复发率低于对照组（P <0.05）。结论 与阴道前后壁修补联合传统阴式子宫切除术相比，阴道前后壁修补联合腹腔镜髂耻韧带悬吊术可缩短POP患者住院时间和手术时间，疗效确切，手术创伤小，增加阴道长度，改善性生活质量、盆底功能及解剖学参数，复发风险小，且安全性良好。

Abstract:

Objective To compare the efficacy of anterior and posterior vaginal wall repair combined with laparoscopic iliopectineal ligament suspension or conventional transvaginal hysterectomy in treating pelvic organ prolapse (POP).Methods A total of 82 patients with POP who received treatment in our hospital from February 2020 to October 2021 were selected and divided into the study group (n = 41) and the control group (n = 41) by the random number table method. The control group underwent conventional transvaginal hysterectomy plus anterior and posterior vaginal wall repair, while the study group underwent laparoscopic iliopectineal ligament suspension plus anterior and posterior vaginal wall repair. Both groups were evaluated 6 months after the operation. The surgical indicators, functional anatomic parameters of the pelvic floor, function of the pelvic floor, sexual quality of life and complications of the two groups were compared. The objective cure rate and recurrence rate of the two groups were observed 12 months after the surgery.Results The amount of intraoperative blood loss in the study group was lower than that in the control group (P < 0.05). The postoperative vaginal length in the study group was longer than that in the control group (P < 0.05). The postoperative length of hospital stays and the operative duration in the study group were shorter than those in the control group (P < 0.05). The differences of the locations of points Ba (the most distal portion of the remaining upper anterior side of the vaginal wall to the hymen), Bp (the most distal portion of the remaining upper posterior side of the vaginal wall to the hymen), Aa (the midline of anterior vaginal wall 3 cm proximal to the hymen), C (the lowest edge of the cervix or the vaginal cuff), and Ap (the midline of posterior vaginal wall 3 cm proximal to the hymen) before and after the surgery in the study group were lower than those in the control group (P < 0.05). The differences of Pelvic Floor Distress Inventory-20 (PFDI-20) scores and Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7) scores before and after the surgery in the study group were higher than those in the control group (P < 0.05). The differences of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) scores and Female Sexual Function Index (FSFI) scores before and after the surgery in the study group were also higher than those in the control group (P < 0.05). The overall incidence of complications in the study group was lower than that in the control group (P < 0.05). The objective cure rate of the study group was higher than that of the control group (P <0.05), and the recurrence rate of the study group was lower than that of the control group (P < 0.05).Conclusions Compared with anterior and posterior vaginal wall repair plus conventional transvaginal hysterectomy, anterior and posterior vaginal wall repair plus laparoscopic iliopectineal ligament suspension is more effective in treating POP and shortens the length of hospital stays and the operative duration of POP patients with less surgical trauma. Besides, it increases the vaginal length, improves the sexual quality of life and the function and anatomical parameters of the pelvic floor, and reduces the risk of recurrence with a good safety profile.