传统术式与盆底重建术治疗盆腔脏器脱垂的疗效分析

发布时间：2018-08-09 14:39

【摘要】：目的：分析比较传统术式与盆底重建术治疗盆腔脏器脱垂（POP）的疗效。方法：选择2010年1月至2014年1月期间因POP而手术治疗的患者139例为研究对象。分为无补片组77例（包括曼氏手术35例、经阴子宫切除术+阴道前后壁修补术42例）和补片组62例（包括Prolift补片25例、Avaulta补片22例、Prosima补片15例）两组。比较两组患者手术时间、术中出血量、手术费用、住院天数，作为手术一般情况的分析；术前及术后复诊时POP-Q评分的变化作为客观疗效的分析。电话结合电子邮件的方式随访，无补片组平均随访时间为术后（25.00±14.29）月，而补片组平均随访时间为术后（24.35±10.78）月。两组随访时间差异无统计学意义（P0.05）。比较两组患者术前及随访时盆底障碍量表简表（PFDI-20）、盆底影响问卷简表(PFIQ-7)的相关评分，，作为患者主观疗效及生活质量影响程度的评价。结果：（1）补片组手术时间（62.47±27.83）min少于无补片组（87.40±25.66）min，差异有统计学意义(P0.01)；补片组术中出血量（37.98±16.16）ml少于无补片组（57.27±35.16） ml，差异有统计学意义(P0.01)；无补片组手术费用（11794.77±2990.38）元低于补片组（19425.23±7596.38）元，差异有统计学意义（P0.01）。（2）术前两组患者POP-Q分度差异无统计学意义（P0.05）。两组患者复诊率分别为：补片组98.39%和无补片组93.51%。术后两组患者POP-Q分度差异无统计学意义（P0.05），患者术前与术后复诊时POP-Q分度差异明显，有统计学意义（P0.01）。（3）随访时，补片组PFDI-20评分由术前的（69.72±19.04）分降为（11.36±6.10）分，PFIQ-7评分由（75.90±19.19）分降为（14.75±6.83）分；无补片组PFDI-20评分由术前的（67.79±17.88）分降为（17.84±6.22）分，PFIQ-7评分由（75.55±17.85）分降为（23.66±11.85）分。两组患者随访时的PFDI-20、PFIQ-7及其分量表评分较术前明显下降，差异有统计学意义（P0.01）。无补片组随访时PFDI-20及其分量表、PFIQ-7、POPIQ-7、UIQ-7评分高于补片组，差异有统计学意义（P0.05）；CRAIQ-7评分高于补片组，但差异无统计学意义（P0.05）。结论：传统手术及补片盆底重建术是POP的有效治疗方式，两者近期解剖学复位疗效相仿，但补片盆底重建术拥有更好的远期主观疗效。补片盆底重建术价格较高，要求患者有一定的经济基础。
[Abstract]:Objective: to compare the efficacy of traditional operation and pelvic floor reconstruction in the treatment of pelvic organ prolapse (POP). Methods: 139 patients with POP from January 2010 to January 2014 were selected. 77 cases (including 35 cases of Mann's operation, 42 cases of transvaginal hysterectomy) and 62 cases of patch group (including 25 cases of Prolift patch and 22 cases of Prosima patch) were divided into two groups. The time of operation, the amount of blood lost during operation, the cost of operation and the days of hospitalization were compared between the two groups. The changes of POP-Q score before and after operation were analyzed as objective curative effect. The average follow-up time was (25.00 卤14.29) months in the non-patch group and (24.35 卤10.78) months in the patch group. There was no significant difference in follow-up time between the two groups (P0.05). The correlation scores of pelvic floor disorder scale (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7) were compared between the two groups as the evaluation of subjective curative effect and quality of life (QOL). Results: (1) the operative time was (62.47 卤27.83) min in the patch group and (87.40 卤25.66) minutes in the non-patch group, the difference was statistically significant (P0.01), and the intraoperative bleeding volume in the patch group was (37.98 卤16.16) ml lower than that in the non-supplement group (57.27 卤35.16) ml (P0.01). The cost of operation in the non-supplement group (11794.77 卤2990.38) yuan was lower than that in the supplement group (19425.23 卤7596.38) yuan, the difference was statistically significant (P0.01). (2). There was no significant difference in the POP-Q score between the two groups before operation (P0.05). The follow-up rate of the two groups was 98.39% in the patch group and 93.51% in the control group. There was no significant difference in POP-Q score between the two groups after operation (P0.05). There was a significant difference in POP-Q score between the patients before and after follow-up (P0.01). (3). The PFDI-20 score of the supplement group was decreased from (69.72 卤19.04) to (11.36 卤6.10) and that of the non-supplement group from (75.90 卤19.19) to (14.75 卤6.83), from (67.79 卤17.88) to (17.84 卤6.22), from (75.55 卤17.85) to (23.66 卤11.85). The PFDI-20 PFIQ-7 and its subscale scores in the two groups were significantly lower than those before operation (P0.01). The scores of PFDI-20 and its components in the follow-up group were higher than those in the supplement group (P0.05), but the difference was not statistically significant (P0.05). Conclusion: traditional surgery and pelvic floor reconstruction are effective methods for POP. The effect of anatomical reduction is similar in the near future, but the reconstruction of pelvic floor repair has better long-term subjective effect. The price of pelvic floor reconstruction is high, requiring patients to have a certain economic base.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713

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