腹腔镜下经腹壁阴道残端悬吊术治疗中重度子宫脱垂临床研究

发布时间：2019-01-02 07:24

【摘要】：目的:探讨腹腔镜下经腹壁阴道残端悬吊术预防术后阴道残端再脱垂的效果研究。方法:统计2012年10月至2014年10月在山东省临沂市人民医院妇科一病区收治的子宫脱垂患者65例,其中34例作为研究组行经阴道子宫切除术+阴道前后壁修补术+腹腔镜下经腹壁阴道残端悬吊术,31例作为对照组行传统经阴道子宫切除术+阴道前后壁修补术。记录术前子宫脱垂分期、患者手术时间、术中出血量、术后残余尿、住院时间、术后感染率等,术后3、6、12、18、24个月进行随访,行阴道残端(POP-Q分期C点)测量,观察患者术后阴道残端(C点)位置。结果:研究组34例患者完成经阴道切除子宫腹腔镜下经腹壁阴道残端悬吊术,仅1例患者术后下腹壁牵拉不适感明显,行走时加重,经过一段时间适应后不适感逐渐消失,术后阴道残端(即C点)无再脱垂发生。对照组:有2例患者术后阴道残端降至"-1 "水平,1例患者术后阴道残端降至"0"水平(复发率9.67%,3/31)。术后3、6、12、18、24个月随访结果,阴道残端位置:研究组高于对照组。结论:腹腔镜下经腹壁阴道残端悬吊术手术风险小,对操作技术要求相对较低,术后随访2年3 4例患者未出现阴道残端再脱垂,明显减少了传统经阴道子宫切除加前后阴道壁修补术式术后阴道残端(POP-Q分期C点)再脱垂的几率。
[Abstract]:Objective: to study the effect of laparoscopic vaginal stump suspension on vaginal stump prolapse. Methods: from October 2012 to October 2014, 65 patients with uterine prolapse were treated in the first gynecological ward of Linyi City people's Hospital, Shandong Province. 34 cases were treated as the study group by transvaginal hysterectomy and anterior and posterior vaginal wall repair under laparoscope, 31 cases as the control group were treated with traditional vaginal hysterectomy and anterior and posterior vaginal wall repair. Preoperative uterine prolapse stage, operative time, intraoperative bleeding volume, postoperative residual urine, hospitalization time, postoperative infection rate and so on were recorded. All patients were followed up for 24 months. Vaginal stump (point C of POP-Q staging) was measured. The position of vaginal stump (point C) after operation was observed. Results: 34 patients in the study group underwent transvaginal hysterectomy and laparoscopic vaginal stump suspension. Only one patient had obvious lower abdominal wall traction discomfort and increased discomfort during walking. After a period of adaptation, the discomfort gradually disappeared. There was no recurrence of vaginal stump (point C) after operation. In the control group, vaginal stump decreased to "-1" level in 2 cases and "0" level in 1 case (recurrence rate was 9.67 / 31). The results of 24 months follow-up showed that the position of vaginal stump was higher in the study group than in the control group. Conclusion: laparoscopic transabdominal vaginal stump suspension is less risky and requires relatively low technical requirements, and no vaginal stump prolapse was found in 34 patients followed up for 2 years. The rate of vaginal stump (POP-Q stage C point) after traditional transvaginal hysterectomy plus anterior and posterior vaginal wall repair was significantly reduced.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713

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