对盆底重建术与腹腔镜阴道骶骨固定术治疗盆腔脏器脱垂的综合评价

发布时间：2018-01-17 17:32

本文关键词：对盆底重建术与腹腔镜阴道骶骨固定术治疗盆腔脏器脱垂的综合评价　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探究盆底重建术与腹腔镜阴道骶骨固定术治疗盆腔脏器脱垂的临床疗效及安全性,比较两术式的优劣及适应症,以期为临床实践提供理论基础。方法:回顾性统计分析自2013年9月至2016年9月因盆腔脏器脱垂于青岛大学附属医院妇科行手术治疗的103例患者的相关资料,其中行盆底重建术者62例(均为全盆重建术),行腹腔镜下阴道骶骨固定术者41例(术中均同时切除子宫),对比两组患者围手术期相关临床资料、并发症及术后随访资料,探究两种手术方式的安全性及临床疗效。本研究中的所有数据采用SPSS 19.0软件进行统计学分析。结果:1、基本资料分析:盆底重建组患者平均年龄为62.85±8.74岁,高于骶骨固定组(56.37±11.62岁,P0.05),而两组患者在孕产次、体质指数及是否合并内科疾病及压力性尿失禁等的比较中未见统计学差异。2、手术相关参数比较:盆底重建组患者的平均手术时间为94.37±32.63min,明显低于腹腔镜下骶骨固定组(157.64±41.28min),而且该组患者术中出血量也明显少于骶骨固定组(35.63±15.45vs 75.57±30.77ml),差异均有统计学意义(P0.05)。两组患者术后尿管留置时间、住院天数及手术费用的比较中未见统计学差异。3、围手术期并发症:盆底重建组围手术期共有3例患者出现手术相关并发症,发生率为4.84%(3/62),与骶骨固定组相比(4.87%,2/41),两组间差异没有统计学意义。两组患者术中均未发生盆腔重要脏器、大血管及神经损伤。4、网片相关并发症:随访61例盆底重建患者,均未发生网片暴露,但有2例患者术后表现慢性盆腔疼痛(3.27%,2/61);而骶骨固定组中有2例患者出现网片暴露(5%,2/40),未发生慢性盆腔疼痛的情况,差异有统计学意义(P0.05)。5、随访资料分析:103例患者中有101例患者完成术后随访(98%)。两组患者术后POP-Q评分均较术前明显改善,客观治愈率均为100%,且随访期间均无复发。两组患者术前与术后半年PFDI-20评分及PFDI-7评分均较前明显好转,差异有统计学意义(P0.05),而两组间评分则无显著差异。两组患者性生活质量评分(PISQ-12)存在显著差异,其中骶骨固定组患者评分(79.8±4.6)明显高于盆底重建组(61.6±10.2)。两组患者术后新发尿失禁情况无明显差异。结论:盆底重建术及腹腔镜阴道骶骨固定术均疗效明确、并发症低,是治疗盆腔脏器脱垂安全、有效的手术方式。两术式各有利弊,临床工作中,应根据患者的意愿、年龄、脏器脱垂的程度、患者对性生活的要求度以及患者的经济条件等因素进行综合考虑,从而实现个体化手术方式。
[Abstract]:Objective: to investigate the clinical efficacy and safety of pelvic floor reconstruction and laparoscopic vaginal sacral fixation in the treatment of pelvic organ prolapse. Methods:. From September 2013 to September 2016, the data of 103 patients undergoing gynecological surgery for pelvic viscera prolapse in the affiliated hospital of Qingdao University were analyzed retrospectively. Among them, 62 cases underwent pelvic floor reconstruction (total pelvic reconstruction) and 41 cases underwent laparoscopic vaginal sacrum fixation. Complications and postoperative follow-up data to explore the safety and clinical efficacy of the two surgical methods. All the data in this study were statistically analyzed by SPSS 19.0 software. Results: 1. Analysis of basic data: the average age of pelvic floor reconstruction group was 62.85 卤8.74 years old, which was higher than that of sacral fixation group (56.37 卤11.62 years old) (P 0.05). There was no significant difference in body mass index (BMI) and stress urinary incontinence between internal diseases and stress urinary incontinence. Comparison of operative parameters: the mean operation time of pelvic floor reconstruction group was 94.37 卤32.63 min, which was significantly lower than that of laparoscopic sacral fixation group (157.64 卤41.28 min). The amount of intraoperative bleeding in this group was significantly lower than that in the sacral fixation group (35.63 卤15.45 vs 75.57 卤30.77 ml). The difference was statistically significant (P 0.05). There was no statistical difference between the two groups in the time of indwelling urinary catheter, the days of hospitalization and the cost of operation. Perioperative complications: in pelvic floor reconstruction group, there were 3 cases of perioperative complications, the incidence was 4.84 / 62%, compared with the sacral fixation group, 4.87% of 41). There was no significant difference between the two groups. During the operation, there were no major pelvic organs, large vessels and nerve injury .4. net related complications: 61 cases of pelvic floor reconstruction patients were followed up, none of them had any net exposure. But there were 2 patients with chronic pelvic pain who had 2 / 61s of chronic pelvic pain. In the sacral fixation group, there were 2 cases with net exposure of 5 / 40%, and no chronic pelvic pain occurred. The difference was statistically significant (P 0.05). Follow-up data analysis: 101 out of 103 patients were followed up after operation. The POP-Q scores of the two groups were significantly improved compared with those before operation, and the objective cure rate was 100%. There was no recurrence during the follow-up period. The PFDI-20 score and PFDI-7 score of the two groups were significantly improved before and after operation (P 0.05). However, there was no significant difference in scores between the two groups, but there was a significant difference in the scores of sexual life quality and PISQ-12 between the two groups. The score of sacral fixation group (79.8 卤4.6) was significantly higher than that of pelvic floor reconstruction group (61.6 卤10.2). Conclusion: pelvic floor reconstruction and laparoscopic vaginal sacral fixation are effective. The complications are low, which is a safe and effective way to treat pelvic organ prolapse. There are advantages and disadvantages between the two methods. In clinical work, according to the wishes of patients, age, organ prolapse degree. In order to realize the individualized operation mode, the factors such as the requirement of sexual life and the economic condition of the patients were comprehensively considered.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713

【参考文献】