腹腔镜骶骨阴道固定术临床疗效评价

发布时间：2018-05-30 11:43

  本文选题：腹腔镜骶骨阴道固定术 + 盆腔器官脱垂　； 参考：《河北医科大学》2014年硕士论文

【摘要】：目的：评估腹腔镜骶骨阴道固定术(laparoscopic sacral colpopexy，LSC)治疗盆腔器官脱垂(pelvic organ prolapse，POP)的临床疗效及安全性。 方法：回顾性分析2008年11月至2014年2月在河北医科大学第二医院由同一医生完成LSC治疗的29例中、重度POP患者的临床资料。应用盆腔器管脱垂定量分期法(pelvic organ prolapse quantitation，POP-Q)对POP患者进行分度，使用盆底功能障碍性疾病症状问卷简表(pelvic floordistress inventory-short form20，PFDI-20)和盆底疾病生活质量影响问卷短表(pelvic floor impact questionnaire-short form7，PFIQ-7)评估患者症状和健康相关生活质量（health-related quality of life，HRQL)，采用POP/尿失禁性生活问卷（pelvic organ prolapse-urinary incontinence sexualquestionnaire，PISQ-12)评估患者的性生活质量。术后1月、6月、12月及每年进行随访，将随访结果与术前数据进行比较，评估LSC的手术疗效。同时观察手术时间、术中出血等指标，记录住院费用等综合评估手术安全性和经济负担。 结果：平均手术时间为228.1±35.2min(130~280min)，，术中平均出血量120.0±76.0ml(50~400ml)，术后体温超过38.5℃者2例（6.9%，2/29），术后平均留置尿管3.0±1.1d (2~7d)，术后平均住院时间4.9±1.1d(4~5d)，住院总费用22170.5±5410.3元。29例患者随访1~64个月，中位随访时间14.0个月，术后6月、12月POP-Q各指示点位置与术前相比得到明显改善(P0.05)，术后6月与12月结果之间差异无统计学意义(P0.05)，解剖学上LSC术后阴道顶端得到良好复位，仅有1例患者出现阴道前壁脱垂Ⅱ度，客观治愈率96.6%（28/29）。PFDI-20、PFIQ-7和PISQ-12评分术前分别为101.9±13.4、98.2±11.9、20.6±1.8，术后6个月分别为38.4±19.7、12.8±6.6、22.7±2.8，术后12个月分别为39.9±18.7、13.3±6.2、23.4±2.6，术后6月与术后12月各评分分别与术前比较差异有统计学意义(P0.05)，术后6月与术后12月各评分之间差异无统计学意义(P0.05)。有1例患者发生术中穿透骶中静脉，经骨蜡等压迫止血后好转。1例（3.4%）术后新发SUI。5例术前排便困难或便秘，术后1个月内症状仍明显，其中3例在术后6个月缓解。术后新发便秘者2例（6.9%），其中1例术后3月内缓解。1例术后性交不适，经心理疏导后缓解。总的主观治愈率86.2%（25/29）。随访期间，未见网片侵蚀、暴露、感染等并发症。 结论: LSC是一种微创、安全、有效的手术方式，主、客观治愈率高，不仅能达到解剖学复位，还能显著改善患者症状、生活质量和性生活质量。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of laparoscopic sacral colpopexy (LSC) in the treatment of pelvic organ prolapse (POP). Methods: the clinical data of 29 patients with severe POP who were treated by the same doctor in the second Hospital of Hebei Medical University from November 2008 to February 2014 were analyzed retrospectively. The pelvic tube prolapse quantitative staging method was used to classify the patients with POP. Pelvic floordistress inventory-short form20PFDI-20) and pelvic floor disease quality of life (PFIQ-7) were used to evaluate patients' symptoms and health-related quality of life (HRQLL), and POP/ urinary incontinence was used to ask about sexual life. Volume pelvic organ prolapse-urinary incontinence sexualquestionnaire PISQ-12) assess the patient's sexual quality. All patients were followed up for 1 month, 6 months, 12 months and every year. The results of follow-up were compared with preoperative data to evaluate the curative effect of LSC. At the same time, the operation time, intraoperative bleeding and hospital expenses were observed to evaluate the operation safety and economic burden. Results: the average operative time was 228.1 卤35.2min / 130 ~ 280min, the average blood loss during operation was 120.0 卤76.0ml / 50ml / 400ml / L, and the temperature was over 38.5 鈩

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