三种不同术式治疗重度盆腔器官脱垂的临床研究

发布时间：2018-06-21 19:16

本文选题：盆腔器官脱垂 + 经阴道骶棘韧带悬吊术　；参考：《南昌大学》2015年硕士论文

【摘要】：目的:比较经阴道骶棘韧带悬吊术(VSSLF)、全盆底重建术、经阴道全子宫切除+阴道前/后壁修补术三种术式对重度盆腔器官脱垂(POP)的临床疗效,探讨VSSLF临床应用的价值。方法:选择江西省人民医院2009年1月-2011年12月因盆腔器官脱垂POP-Q评分为Ⅲ、Ⅳ期,要求手术治疗的患者90例,分别采用VSSLF(A组,30例)、全盆底重建术(B组,30例)、经阴道全子宫切除+阴道前/后壁修补术(C组,30例),分别对三组的术中情况(手术时间、出血量、术中并发症),术后各项指标(术后病率、住院时间、住院费用、近期并发症),术后随访(阴道长度、各指示点POP-Q评分、远期并发症、复发率、性生活满意度及生活质量)进行对比。结果:A组的手术时间和术中出血量均少于B组和C组(P0.05);三组均未发生术中并发症;三组的术后病率和住院时间等方面均无明显差异(P0.05);A组的住院费用与C组相近(P0.05),但低于B组(P0.05);A组术后3个月的阴道长度大于B组和C组(P0.05);三组术后3个月Ba、Bp、C点的POP-Q评分均较术前有明显改善(P0.05),其中A组C点位置高于B组和C组(P0.05);A组与B组的术后2年性生活满意度及生活质量相当(P0.05),均高于C组(P0.05);A组术后2年的复发率与B组相当(P0.05),但低于C组(P0.05)。结论:VSSLF:相对于经阴道全子宫切除+阴道前/后壁修补术,手术时间短,损伤小,出血少,性生活影响小,且可保留子宫;相对于全盆底重建术,则费用低,并发症少。是一种微创、经济、安全、且不改变盆底解剖结构及功能的术式,值得临床推广。
[Abstract]:Objective: to compare the clinical effects of VSS LFN, total pelvic floor reconstruction and transvaginal hysterectomy for severe pelvic organ prolapse (POP) by vaginal sacral ligamentum suspension (VSS LFN), total pelvic floor reconstruction (TPD) and transvaginal total hysterectomy (TTC) for the treatment of severe pelvic organ prolapse (POP), and to evaluate the clinical value of VSSLF in the treatment of severe pelvic organ prolapse. Methods: from January 2009 to December 2011, 90 patients with pelvic organ prolapse were selected from Jiangxi Provincial people's Hospital. VSS LFA group (n = 30), total pelvic floor reconstruction (group B) (n = 30) and vaginal hysterectomy with anterior / posterior wall repair (n = 30) were used respectively. Intraoperative complications, postoperative indicators (postoperative disease rate, hospital stay, hospitalization costs, short-term complications, postoperative follow-up (vaginal length, POP-Q score at each indication point, long-term complications, recurrence rate, etc.) Sexual satisfaction and quality of life) were compared. Results the operative time and intraoperative blood loss in group 1 were less than those in group B and group C (P 0.05), and no intraoperative complications were found in the three groups. There was no significant difference in postoperative morbidity and hospitalization time among the three groups. The hospitalization cost of group A was similar to that of group C, but lower than that of group B, the length of vagina 3 months after operation in group A was larger than that in group B and group C, and the POP-Q at point BaBpC of group A was higher than that of group B 3 months after operation. The scores in group A were higher than those in group B and group C, and the satisfaction and quality of life in group A and group B were similar to those in group B and group B, which were higher than those in group C and group B respectively. The recurrence rate of group A and group B was higher than that of group C and group B. The recurrence rate of group A was significantly higher than that of group A and group B, and the recurrence rate of group A was higher than that of group A and group B. When P0. 05, but lower than group C, P0. 05. Conclusion compared with the transvaginal total hysterectomy of anterior / posterior wall of vagina, the operation time is shorter, the injury is less, the bleeding is less, the sexual life is less, and the uterus can be preserved, compared with the whole pelvic floor reconstruction, the cost is low and the complications are less. It is a minimally invasive, economical, safe, and does not change the pelvic floor anatomical structure and function, worthy of clinical promotion.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R713

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