改良曼氏手术治疗重度盆腔器官脱垂伴宫颈延长的短期疗效

发布时间：2019-01-01 11:40

【摘要】：目的探讨改良曼氏手术治疗重度盆腔器官脱垂伴宫颈延长的疗效及对患者生活质量的影响。方法选择2012年1月至2013年4月Ⅲ~Ⅳ期盆腔器官脱垂92例患者,其中50例伴宫颈延长患者行改良曼氏手术作为改良曼氏组,42例行植入网片的盆底重建术作为植入网片组。比较两组患者的手术时间、术中出血量、尿管保留时间、术后住院时间、总住院时间及总住院费用;术后1、6、12个月进行随访,填写盆底功能障碍问卷简表20(PFDI-20)、盆底功能影响问卷简表7(PFIQ-7)及盆底器官脱垂/尿失禁性生活影响问卷(PISQ-12),评估手术对患者生活质量和性生活质量的影响。结果改良曼氏组与植入网片组的手术时间[(86.3±19.0)min,(83.7±20.3)min]、出血量[(82.9±80.6)ml,(67.0±52.1)ml]比较,差异无统计学意义(P0.05)。两组保留尿管时间[(4.4±1.6)d,(3.5±1.1)d)]、术后恢复时间[(7.7±2.2)d,(6.3±1.6)d]、总住院时间[(12.5±2.4)d,(9.7±2.7)d]、住院费用[(22 919.5±6 413.3)元,(6 513.5±2 329.3)元]比较,差异均有统计学意义(P均0.01)。植入网片组术前和术后12个月PFDI-20评分分别为(80.6±57.9)分和(30.2±73.8)分;PFIQ-7分别为(84.4±45.5)分和(27.8±33.4)分;改良曼氏组术前和术后12个月PFDI-20评分分别为(74.0±66.0)分和(10.0±23.0)分;PFIQ-7评分分别为(68.5±45.8)分和(18.3±30.3)分,两组术前、术后比较,差异均无统计学意义(P0.05)。植入网片组尿潴留2例,网片暴露1例;改良曼氏组尿潴留1例,两组患者均无复发。结论改良曼氏手术是治疗伴宫颈延长重度POP有效、安全、微创的手术之一,可以明显改善患者的生命质量,与植入网片盆底重建术疗效相当。
[Abstract]:Objective to investigate the effect of modified Mann's operation on severe pelvic organ prolapse with cervical extension and its effect on quality of life (QOL). Methods from January 2012 to April 2013, 92 patients with pelvic organ prolapse were selected. Among them, 50 patients with cervical extension underwent modified Mann's operation and 42 patients underwent pelvic floor reconstruction with mesh implantation. The operation time, intraoperative bleeding volume, retention time of urinary catheter, postoperative hospitalization time, total hospitalization time and total hospitalization cost were compared between the two groups. The patients were followed up at 1: 6 and 12 months after operation. The pelvic floor dysfunction questionnaire (PFDI-20), pelvic floor function impact questionnaire (PFIQ-7) and pelvic floor prolapse / urinary incontinence (PISQ-12) were completed. To evaluate the effect of surgery on patients' quality of life and sexual life. Results there was no significant difference in operative time (86.3 卤19.0) min, (, 83.7 卤20.3 min) and blood loss (82.9 卤80.6) ml, (, 67.0 卤52.1) ml) between the modified Mann group and the mesh implantation group (P0.05). The duration of retention of urinary catheter [(4.4 卤1.6) d, () 3.5 卤1.1) d)], postoperative recovery time [(7.7 卤2.2) d, (6.3 卤1.6) days], total hospitalization time [(12.5 卤2.4) days] in both groups. The cost of hospitalization [(22 919.5 卤6 413.3) yuan, (6 513.5 卤2 329.3) yuan] was significantly different (P < 0. 01). The PFDI-20 scores were (80.6 卤57.9) and (30.2 卤73.8), the PFIQ-7 scores were (84.4 卤45.5) and (27.8 卤33.4) in the mesh implantation group. The PFDI-20 scores before and 12 months after operation were (74.0 卤66.0) and (10.0 卤23.0) in modified Mann's group. The PFIQ-7 scores were (68.5 卤45.8) and (18.3 卤30.3), respectively. There was no significant difference between the two groups before and after operation (P0.05). There were 2 cases of urinary retention and 1 case of net exposure in the implanted mesh group, and 1 case in the modified Mann group. No recurrence was found in both groups. Conclusion modified Mann's operation is one of the effective, safe and minimally invasive procedures for the treatment of severe POP with cervical extension. It can significantly improve the quality of life of the patients and is comparable to the effect of pelvic floor reconstruction.
【作者单位】：首都医科大学附属北京妇产医院;
【基金】：北京市科学技术委员会首都市民健康项目培育(Z111107067311024)
【分类号】：R713

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