CAJ | 학술논문

目的探讨经阴道子宫骶骨韧带高位悬吊术(HUS)治疗重度盆腔器官脱垂(POP)的长期主、客观疗效.方法 2003年6月至2013年3月,解放军总医院第一附属医院共对136例POP定量(POP-Q)分度法Ⅲ～Ⅳ度的POP患者行经阴道子宫切除及HUS,对获得随访的125例患者的临床资料进行回顾性分析.阴道前壁修补99例(79.2％,99/125),其中前壁Ⅲ度以上脱垂者中65％(53/81)加用了网片,后壁修补80例(64.0％,80/125),后壁Ⅲ度以上脱垂者中15％(5/34)加用网片.47例术前有压力性尿失禁者同时行耻骨后或经闭孔阴道无张力尿道中段悬吊带术,96.0％(120/125)的患者同时行肛提肌及会阴体修补术.术后5年对患者的主、客观疗效进行回顾性分析,包括围手术期情况以及近远期并发症.手术客观治愈标准为脱垂器官最远端与处女膜水平的距离＜0 cm;主观改善情况通过比较患者手术前、后盆底疾病生命质量影响问卷简表(PFIQ-7)和盆底功能障碍性疾病症状问卷简表(PFDI-20)评分.结果 125例患者平均随访时间(5.4±1.2)年.术后5年中有4例患者阴道前壁轻度膨出,复发率为3.2％ (4/125),但不需再次手术及子宫托治疗.术后5年客观治愈率为96.8％(121/125),主观满意度为94.4％(118/125),PFDI-20,PFIQ-7调查问卷中位评分分别为8、7分,均较术前(分别为62、64分)明显降低(P＜0.01),提示主观症状明显改善.术中3例(2.4％,3/125)患者输尿管被缝扎.术前47例压力性尿失禁患者中术后2例症状未改善,其中1例半年后好转.2例(1.6％,2/125)新发轻度尿失禁,但不需要治疗.结论 HUS用于治疗重度POP疗效持久,主、客观治愈率高,复发率低,安全、有效,值得临床推广应用.
목적 탐토경음도자궁저골인대고위현조술(HUS)치료중도분강기관탈수(POP)적장기주、객관료효.방법 2003년6월지2013년3월,해방군총의원제일부속의원공대136례POP정량(POP-Q)분도법Ⅲ～Ⅳ도적POP환자행경음도자궁절제급HUS,대획득수방적125례환자적림상자료진행회고성분석.음도전벽수보99례(79.2％,99/125),기중전벽Ⅲ도이상탈수자중65％(53/81)가용료망편,후벽수보80례(64.0％,80/125),후벽Ⅲ도이상탈수자중15％(5/34)가용망편.47례술전유압력성뇨실금자동시행치골후혹경폐공음도무장력뇨도중단현조대술,96.0％(120/125)적환자동시행항제기급회음체수보술.술후5년대환자적주、객관료효진행회고성분석,포괄위수술기정황이급근원기병발증.수술객관치유표준위탈수기관최원단여처녀막수평적거리＜0 cm;주관개선정황통과비교환자수술전、후분저질병생명질량영향문권간표(PFIQ-7)화분저공능장애성질병증상문권간표(PFDI-20)평분.결과 125례환자평균수방시간(5.4±1.2)년.술후5년중유4례환자음도전벽경도팽출,복발솔위3.2％ (4/125),단불수재차수술급자궁탁치료.술후5년객관치유솔위96.8％(121/125),주관만의도위94.4％(118/125),PFDI-20,PFIQ-7조사문권중위평분분별위8、7분,균교술전(분별위62、64분)명현강저(P＜0.01),제시주관증상명현개선.술중3례(2.4％,3/125)환자수뇨관피봉찰.술전47례압력성뇨실금환자중술후2례증상미개선,기중1례반년후호전.2례(1.6％,2/125)신발경도뇨실금,단불수요치료.결론 HUS용우치료중도POP료효지구,주、객관치유솔고,복발솔저,안전、유효,치득림상추엄응용.
Objective To investigate the long-term objective and subjective outcomes of the transvaginal high uterosacral ligament suspension (HUS) in treatment of severe pelvic organ prolapse (POP).Methods From Jun.2003 to Mar.2013,136 patients with severe POP quantitation(POP-Q) stage Ⅲ-Ⅳ underwent transvaginal hysterectomy and HUS operation in the First Affiliated Hospital,General Hospital of People's Liberation Army.And 125 patients (91.9％,125/136) were followed up at a mean of 5.4 years(range of 4.2-9.2 years).Anterior colporrhaphy (79.2％,99/125),posterior colporrhaphy (64.0％,80/125),the perineorrhaphy (96.0％,120/125) and tension-free suburethral slings (37.6％,47/125) were performed concurrently,in which 53 (65％,53/81) patients with severe cystocele and 5 patients (15％,5/34) with rectocele were augmented with mesh,respectively.Concurrent operation and complications were studied.The objective success of the operation was defined as the leading vaginal edge above hymen.Subjective results were obtained quality-of-life questionnaires,including pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7).Result The mean interval of following up was (5.4 ± 1.2) years.Four patients presented mild anterior vaginal wall prolapse,and the recurrence rate were 3.2％ (4/125),but no reoperation and pessary treatment were needed.Therefore,the subjective and objective satisfaction rate was 94.4％ (118/125) and 96.8％ (121/125).The mean scores of PFDI-20 and PFIQ-7 at 5 years after the operations were 8,7,significantly lower than 62,64 (P ＜0.01).There were 3 cases of ureter obstruction.Tension-free vaginal tape was performed on 47 cases with stress urinary incontinence (SUI) as indicated.The symptom of 2 patients was not improved significantly after the operation,but one was improved after 6 months.The rate of denovo SUI was in 2(1.6％,2/125) patients,but no further treatment was needed.Conclusions The transvaginal HUS was then conformed to be a safe,minimal traumatic,highly successful and durable procedure for severe POP,so it is worthy of being popularized for clinical application.