骶主韧带—阴道环重建术在治疗和预防盆腔器官脱垂中的临床应用

发布时间：2018-06-26 21:02

本文选题：骶主韧带-阴道环重建术 + I期盆腔器官脱垂　；参考：《宁夏医科大学》2014年硕士论文

【摘要】：第一部分骶主韧带-阴道环重建术在治疗I期盆腔器官脱垂中的临床应用目的探讨骶主韧带-阴道环重建术在治疗I期盆腔器官脱垂中的疗效，并探讨其对患者术后生活质量的影响。方法选取患有子宫良性病变且合并I期盆腔器官脱垂患者60例，根据患者术前知情同意情况其中30例行经腹全子宫切除术+骶主韧带-阴道环重建术（A悬吊组），另30例行单纯经腹子宫全切术（A对照组），术前、术后1月、3月、6月根据POP-Q分度、阴道长度等指标判断疗效、生活质量问卷（PFID--20)评估患者生活质量。（本研究已通过伦理学标准，并与患者签署同意书）结果A悬吊组与A对照组在疾病分布、年龄、产次、术前POP-Q分度、术前PFID--20评分及平均手术时间、术中出血量等方面无明显差异（P0.05）；A悬吊组与A对照组在疾病分布、年龄、产次、术前POP-Q分度、术前PFID--20评分及平均手术时间、术中出血量等方面无明显差异（P0.05）；术后1月、3月、6月A悬吊组C点测量值分别为-8.13±0.68、-8.11±0.75、-8.18±0.68，A对照组C点测量值分别为-7.15±1.27、-6.90±1.27、-6.81±1.24，两组比较差异显著（P0.05）；术后1月、3月、6月悬吊组Aa点测量值分别为-2.51±0.49、-2.41±0.49、-2.46±0.49，对照组分别为-1.97±0.97、-1.95±0.15、-1.98±0.15，两组比较有显著差异（P0.05）；术后1月、3月、6月A悬吊组Ba点测量值分别为-2.90±0.30、-2.86±0.34、-2.88±0.31,A对照组分别为-2.50±0.41、-2.41±0.43、-2.43±0.44，两组比较有显著差异（P0.05）；术后1月、3月、6月A悬吊组Ap点测量值分别为-2.40±0.57、-2.36±0.57、-2.46±0.58，A对照组分别为-1.81±0.30、-1.83±0.30、-1.86±0.36，两组比较有显著差异（P0.05）；术后1月、3月、6月A悬吊组Bp点测量值分别为-2.86±0.31、-2.90±0.27、-2.86±0.29，A对照组分别为-2.36±1.01、-2.35±1.00、-2.30±1.01，两组比较有显著差异（P0.05）；生活质量问卷评分A悬吊组术后1月、3月、6月分别为35.57±9.87、33.63±9.66、32.23±9.42，A对照组分别为43.37±5.82、43.20±5.85、44.73±6.14，两组比较有显著差异（P0.05）。结论骶主韧带-阴道环重建术可重建阴道环代替宫颈环的盆底支持作用，治疗I期盆腔器官脱垂，改善患者术后生活质量，临床疗效肯定，副作用少。第二部分骶主韧带-阴道环重建术在预防子宫全切术后盆腔器官脱垂中的临床应用目的探讨骶主韧带-阴道环重建术在预防子宫全切术后盆腔器官脱垂中的可行性及其对患者术后生活质量的影响。方法选取患有子宫良性病变且排除盆腔器官脱垂患者50例，根据患者术前知情同意情况取其中20例行经腹全子宫切除术+骶主韧带-阴道环重建术（B悬吊组）；另30例行单纯经腹子宫全切术（B对照组），术前、术后1月、3月、6月根据POP-Q分度、阴道长度等指标判断疗效、生活质量问卷（PFID--20)评估患者生活质量。（本研究已通过伦理学标准，并与患者签署同意书）结果B悬吊组与B对照组在疾病分布、年龄、产次、术前POP-Q分度、术前PFID--20评分及平均手术时间、术中出血量等方面无明显差异（P0.05）；术后1月、3月、6月B悬吊组Aa点测量值分别为-3.00±0.00、-2.82±0.37、-2.70±0.47，，B对照组分别为-2.96±0.18、-2.86±0.34、-2.76±0.43，两组相比较，差异无统计学意义（P0.05）。术后1月、3月、6月B悬吊组Ba点测量值分别为-3.00±0.00、-2.97±0.11、-2.87±0.31，B对照组分别为-2.98±0.09、-3.00±0.00、-2.90±0.30，两组同期相比较，无明显差异（P0.05）；术后1月、3月、6月B悬吊组Ap点测量值分别为-3.00±0.00、-3.00±0.00、-2.80±0.41，B对照组分别为-3.00±0.00、-2.86±0.31、-2.55±0.49，两组同期相比较，术后3月及6月B悬吊组均高于B对照组，差异显著（P0.01）；术后1月、3月、6月B悬吊组Bp点测量值分别为-3.00±0.00、-3.00±0.00、-2.95±0.22，B对照组分别为-3.00±0.00、-2.98±0.09、-2.81±0.36，两组同期相比较，术后6月B悬吊组均高于B对照组，差异显著（P0.01），而术后1月及3月无显著差异（P0.05）。术后1月、3月、6月B悬吊组C点测量值分别为-8.75±0.41、-8.82±0.37、-8.20±0.65，B对照组C点测量值分别为-7.98±0.72、-7.20±2.74、-6.50±0.97，同一月份比较，两组无显著差异（P0.05）。生活质量问卷评分B悬吊组术后1月、3月、6月分别为37.95±8.38、39.95±6.37、39.25±8.22，B对照组分别为42.30±4.97、44.77±6.27、46.67±6.68，两组同期相比较，术后1月B悬吊组明显低于B对照组有显著差异（P0.05），术后3月、6月两组相比较无明显差异（P0.05）结论骶主韧带-阴道环重建术可重建阴道环代替宫颈环的盆底支持作用，能够一定程度上预防子宫全切术后盆腔器官脱垂的发生，尤其对于阴道后壁脱垂及穹窿脱垂疗效肯定，但需延长随访时间观察其确切疗效。
[Abstract]:Part one
Clinical application of sacral main ligament vaginal ring reconstruction in the treatment of pelvic organ prolapse in stage I
Objective to explore the effect of sacral main ligament vaginal ring reconstruction in the treatment of pelvic organ prolapse in stage I, and to explore its effect on postoperative quality of life.
Methods 60 patients with benign uterine lesions and I stage pelvic organ prolapse were selected. According to the preoperative informed consent of the patients, 30 cases were treated by abdominal total hysterectomy plus sacral ligaments vaginal ring reconstruction (A suspension group), and the other 30 cases with simple abdominal hysterectomy (A control group), preoperative, January, March, June, according to the POP-Q degree, Yin. The quality of life questionnaire (PFID--20) was used to assess the quality of life of patients.
Results there was no significant difference between A suspension group and A control group in disease distribution, age, birth time, preoperative POP-Q score, preoperative PFID--20 score and average operation time, bleeding amount in operation (P0.05), A suspension group and A control group in disease distribution, age, birth time, preoperative POP-Q degree, preoperative PFID--20 score and mean operation time, intraoperative bleeding, etc. There was no significant difference (P0.05). The measurement values of C points in the A suspension group in January, March and June were -8.13 + 0.68, -8.11 0.75 and -8.18 0.68 respectively. The C points measured in the A control group were -7.15 + 1.27, -6.90 + 1.27 and -6.81 1.24 respectively. The two groups were significantly different (P0.05), and January, March and June respectively. .46 + 0.49, the control group was -1.97 0.97, -1.95 + 0.15, -1.98 + 0.15, and the two groups had significant differences (P0.05). The measurements of Ba points in the A suspension group in January, March, and June were -2.90 + 0.30, -2.86 + 0.34, -2.88 + 0.31 respectively, A control group were -2.50 0.41, 0.43 and 0.44, two groups were significantly different, January, March, 6. The measured values of Ap points in the A suspension group were -2.40 + 0.57, -2.36 + 0.57 and -2.46 0.58, A control group were -1.81 + 0.30, -1.83 + 0.30 and -1.86 + 0.36 respectively. The two groups were significantly different (P0.05). In January, March, June A suspension group were 0.36, 0.27 and 0.29, respectively. The difference between the two groups was 30 + 1.01 (P0.05), and the quality of life questionnaire (qqq) was 35.57 + 9.87,33.63 + 9.66,32.23 + 9.42 after the operation in January, March and June respectively, and the A control group was 43.37 + 5.82,43.20 + 5.85,44.73 + 6.14 respectively. There were significant differences in the two groups (P0.05).
Conclusion the reconstruction of the main sacral ligament and vagina ring can reconstruct the pelvic floor support of the vaginal ring instead of the cervix ring, and treat the I stage pelvic organ prolapse and improve the postoperative life quality of the patients. The clinical effect is positive and the side effects are few.
The second part
Clinical application of sacral main ligament vaginal ring reconstruction in preventing pelvic organ prolapse after total hysterectomy
Objective to explore the feasibility of sacral main ligament vaginal ring reconstruction in preventing pelvic organ prolapse after total hysterectomy and its effect on postoperative quality of life.
Methods 50 patients with benign lesions of the uterus were selected to exclude pelvic organ prolapse. According to the preoperative informed consent of the patients, 20 cases were treated by abdominal total hysterectomy plus sacral ligamentum vagina reconstruction (B suspension group), and the other 30 cases with simple Transabdominal Total resection (B control group), preoperative, January, March, June, according to the POP-Q degree and Yin. The quality of life questionnaire (PFID--20) was used to assess the quality of life of patients.
Results there was no significant difference between B suspension group and B control group in disease distribution, age, birth time, preoperative POP-Q score, preoperative PFID--20 score, average operation time, and intraoperative bleeding volume (P0.05). In January, March, and June B suspension group, Aa points were -3.00 + 0, -2.82 + 0.37, -2.70 + 0.47, B control group were -2.96 0.18 and 0.34 -2.76 + 0.43, two groups compared, the difference was not statistically significant (P0.05). In January, March, June B suspension group Ba point measurements were -3.00 0, -2.97 + 0.11, -2.87 + 0.31, B control groups were -2.98 + 0.09, -3.00 + 0, -2.90 + 0.30, two groups compared, no significant difference (P0.05); January, March, June, suspension group -3.00 + 0, -3.00 + 0, -2.80 + 0.41, B control group were -3.00 0, -2.86 0.31, -2.55 + 0.49, two groups were compared in the same period, the B suspension group in March and June were higher than the B control group, the difference was significant (P0.01); the Bp points of January, March, June B suspension group were respectively 0.49, 0 and 0.22, respectively. 00 + 0, -2.98 + 0.09, -2.81 + 0.36, two groups compared with the same period, in June, the B suspension group was higher than the B control group, the difference was significant (P0.01), but there was no significant difference between January and March (P0.05). The measurement values of C points in B suspension group in January, March and June were -8.75 + 0.41, -8.82 + 0.37, -8.20 + 0.65 respectively. The measurement values of B control group were 0.41, 0.72 and 2., respectively. 74, -6.50 + 0.97, compared with January, there was no significant difference between the two groups (P0.05). The quality of life questionnaire score of the B suspension group was 37.95 + 8.38,39.95 + 6.37,39.25 + 8.22 in June, March and June respectively. The B control group was 42.30 + 4.97,44.77 + 6.27,46.67 + 6.68 respectively. Compared with those in the same period of the two groups, the January B suspension group was significantly lower than the B control group (P0). .05), there was no significant difference between the two groups in March and June after operation (P0.05).
Conclusion the reconstruction of the main ligaments of the sacral ligament and vagina ring can reconstruct the pelvic floor support of the vaginal ring instead of the cervix. It can prevent the occurrence of pelvic organ prolapse to a certain extent, especially for the posterior vaginal wall prolapse and fornix prolapse, but it is necessary to prolong the follow-up time to observe the exact effect.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713

【参考文献】