中国实用妇科与产科杂志

中国实用妇科与产科杂志

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腹腔镜下子宫-阴道骶骨固定术联合多部位修复术治疗中重度盆腔器官脱垂37例临床分析

史玉林，牛菊敏，刘岩松   

  1. 作者单位：沈阳市妇婴医院妇科，辽宁 沈阳 110011
  • 出版日期:2015-03-02 发布日期:2015-04-01

The clinical analysis of combined multiple surgical methods in treating 37 cases of pelvic organ prolapse.

SHI Yu-lin,NIU Ju-min，LIU Yan-song.   

  1. Shenyang Women’s and Children’s Hospital ，Shenyang 110011，China
  • Online:2015-03-02 Published:2015-04-01

摘要：

目的 探讨多术式联合治疗盆腔器官脱垂（POP）的疗效、安全性及并发症。方法 回顾性分析2007年9月至2012年12月在沈阳市妇婴医院联合应用聚丙烯网片腹腔镜下子宫-阴道骶骨固定术联合改良的阴道旁修补术、圆韧带短缩术、骶韧带缩短术治疗的37例中重度POP患者的临床资料。其中合并糖尿病3例，9例合并宫颈延长（行宫颈部分切除术）,合并压力性尿失禁（SUI）9例，合并子宫肌瘤、腺肌病、卵巢囊肿16例（其中2例多发肌瘤、6例单发肌瘤者希望保留子宫，术中同时行肌瘤剔除术；6例行子宫次全切除术；2例卵巢囊肿患者术中行囊肿切除术，术中冰冻病理良性）。既往行子宫次全切除术4例，行子宫全切术1例。患者均有程度不等的性生活不适或性交困难。观察手术时间、术中出血、膀胱功能恢复等，并在术后定期随访，对手术效果进行主客观评价。结果 37例患者盆腔器官脱垂定量系统（POP-Q）分期Ⅱ期10例，Ⅲ期19例，Ⅳ期8例。所有患者经多术式联合治疗均获成功，平均手术时间(153±32)min,平均出血量（185.35±58.40）mL，术后留置尿管(3.0±1.5)d。术后1年复查POP-Q评分较术前明显改善：Aa－2.4 ±0.5，Ba－2.8±0.4，C－7.5±0.9，Ap－2.5±0.5，Bp－2.6±0.4,相关症状消失或明显改善，无性生活不适及性交痛，无网片侵蚀、暴露、感染等并发症。客观治愈率100%。结论 腹腔镜下子宫-阴道骶骨固定术联合多部位修复术治疗盆腔器官脱垂是一种微创、安全、有效的治疗方式。

关键词: 盆腔器官脱垂, 尿失禁, 腹腔镜

Abstract:

Abstract： Objective To analyze the efficacy ,safety and complication of the combination of the traditional surgery with the laparoscopic suspension surgery for pelvic organ prolapse. Methods The present study is a retrospective analysis of the clinical data of 37cases of pelvic organ prolapse receiving surgical treatment in our hospital from September 2007 to December 2012，POP-QⅡ 10cases，POP-QⅢ 19 cases，POP-QⅣ8 cases.All patients underwent the laparoscopic sacral copopexy and traditional vaginal anterior and posterior wall patch，cervical partial amputaton for those 9 patients with cervical extend ,combined laparoscopic sacral ligament fusion，and the round ligament shorten ing with mesh suspension reconstructive pelvic surgery，and 9 patients complicated with severe stress urinary incontinence(SUI) were given transobturator tension-free vaginal tape(TVT-O).Six patients underwent subtotal hysterectomy and 8 patients underwent myomectomy to retain the uterus.The therapeutic effect,the mean operation time,blood loss,time of micturation were observed.Results All the operations were completed successfully.The mean operation time was(153±32)min,the mean blood loss（185.35±58.40）mL ，time of micturation(3.0±1.5)d and ,the follow up duration was 12～53 months.One year of follow-up showed,Aa point －2.4±0.5.Ba point －2.8±0.4，point C －7.5±0.9，Ap point －2.5±0.5 Bp point －2.6±0.4，which were significantly better than that before surgery. All P <0.05. There is no recurrence or erosion and infection or vaginal exposure of path in this group of patients after 1 year.The symptoms of all patients have been alleviated.

Key words: pelvic organ prolapse, urinary incontinence, laparoscopy

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