CAJ | 학술논문

目的：研究单侧骶棘韧带固定术(sacrospinous ligament fixation，SSLF))治疗盆腔脏器脱垂(pelvic organ prolapse，POP)的有效性及安全性。方法回顾性分析我院2005年12月-2012年12月妇产科就诊的80例严重盆腔脏器脱垂且接受单侧SSLF治疗的患者的临床资料，术后6周和6个月进行随访，效果评估包括标准化问卷以及特定部位的阴道检查，并进行POP-Q评分。结果完整随访70例，平均术后随访26.1个月，随访率为87.5%。平均手术时间52(46~110) min，平均失血量83(30~188) ml，平均住院日6.2 d，术后留置尿管平均2.5 d，术后病率17.5%(14/80)。3例(3.7%)盆腔右侧发生血肿，2例(2.8%)术后6个月时阴道穹窿复发。手术成功率85%(68/80)。11例(15.7%)有腰骶部、腹股沟或右侧腹部疼痛，6例(8.6%)伴有新发的压力性尿失禁，2例(2.8%)产生新发的急迫性尿失禁，5例(7.1%)发现缝合线阴道暴露。POP-Q的Aa、Ba、Ap、Bp和D项上，术前与术后差异有统计学意义(P＜0.01)。结论单侧SSLF是治疗盆腔脏器脱垂一种安全、经济有效的方法，尤其适合严重的阴道顶端合并前壁膨出以及POPⅠ、Ⅱ或Ⅲ期的子宫脱垂者，其主要并发症是腰骶部、臀部和腹股沟疼痛以及新发的压力性尿失禁。
목적：연구단측저극인대고정술(sacrospinous ligament fixation，SSLF))치료분강장기탈수(pelvic organ prolapse，POP)적유효성급안전성。방법회고성분석아원2005년12월-2012년12월부산과취진적80례엄중분강장기탈수차접수단측SSLF치료적환자적림상자료，술후6주화6개월진행수방，효과평고포괄표준화문권이급특정부위적음도검사，병진행POP-Q평분。결과완정수방70례，평균술후수방26.1개월，수방솔위87.5%。평균수술시간52(46~110) min，평균실혈량83(30~188) ml，평균주원일6.2 d，술후류치뇨관평균2.5 d，술후병솔17.5%(14/80)。3례(3.7%)분강우측발생혈종，2례(2.8%)술후6개월시음도궁륭복발。수술성공솔85%(68/80)。11례(15.7%)유요저부、복고구혹우측복부동통，6례(8.6%)반유신발적압력성뇨실금，2례(2.8%)산생신발적급박성뇨실금，5례(7.1%)발현봉합선음도폭로。POP-Q적Aa、Ba、Ap、Bp화D항상，술전여술후차이유통계학의의(P＜0.01)。결론단측SSLF시치료분강장기탈수일충안전、경제유효적방법，우기괄합엄중적음도정단합병전벽팽출이급POPⅠ、Ⅱ혹Ⅲ기적자궁탈수자，기주요병발증시요저부、둔부화복고구동통이급신발적압력성뇨실금。
Objective To study the efficiency and safety of unilateral sacrospinous ligament fixation (SSLF) in treatment of pelvic organ prolapse (POP). Methods Clinical data about 80 patients with severe POP who underwent unilateral SSLF in our department from December 2005 to December 2012 were retrospectively analyzed. The patients were followed up from 6th week and 6th month after operation and their POP-Q was scored according to the standard questionnaire investigation and site-specific vaginal examination. Results Seventy (87.5%) out of the 80 patients were followed up with a mean follow-up time of 26.1 months. The average operation time was 52 min, the average blood loss was 83 ml, the average hospital stay time was 6.2 days, the urinary catheter indwelling time was 2.5 days, and the postoperative morbidity was 17.5%. Hematoma was found in the right pelvic of 11 patients (15.7%), vaginal vault prolapse in 2 patients (2.8%), stress incontinence in 6 patients (8.6%), urgent incontinence in 2 patients (2.8%), and vaginal suture exposure in 5 patients(7.1%). The Aa, Ba, Ap, Bp and D of POP-Q were significantly different before and after operation (P<0.01). Conclusion Unilateral SSLF is a safe and effective procedure for POP, especially for stages 1-3 POP. Its main complications are lumbosacral, buttock and inguinal pain and stress incontinence.