中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2013年
8期
570-574
,共5页
张晓薇%许丽%黎燕霞%淦亚萍%陈礼全
張曉薇%許麗%黎燕霞%淦亞萍%陳禮全
장효미%허려%려연하%감아평%진례전
盆腔器官脱垂%腹腔镜检查%妇科外科手术%尿失禁
盆腔器官脫垂%腹腔鏡檢查%婦科外科手術%尿失禁
분강기관탈수%복강경검사%부과외과수술%뇨실금
Pelvic organ prolapse%Laparoscopy%Gynecologic surgical procedures%Urinary incontinence
目的 分析改良腹腔镜下阴道骶骨固定术的临床疗效,评价其对盆腔器官脱垂治疗的有效性和安全性.方法 回顾性分析2008年1月至2012年9月在广州医科大学附属第一医院因盆腔器官脱垂行改良腹腔镜下阴道骶骨固定术的66例患者的临床资料,比较手术前、后盆腔器官脱垂定量(POP-Q)分度法各指示点位置,评价总体客观治愈率及复发率.通过盆底功能障碍性疾病症状问卷简表(PFDI-20)等相关问卷评分评价主观治愈率以及术后尿失禁相关症状改善情况.结果 63例患者获得6 ～57个月的随访,中位随访时间16个月,主观治愈率95％ (60/63).术后POP-Q各指示点可达解剖复位,总体客观治愈率90％ (57/63),总复发率10％ (6/63).术后中位阴道长度为7.5 cm,较术前的8.0cm稍有缩短,两者比较,差异有统计学意义(P＜0.01)；术后PFDI-20中位评分为21分,较术前的75分明显改善,两者比较,差异有统计学意义(P＜0.05)；术后随访＞3年、＞2～≤3年、＞1～≤2年、＞0.5～1年患者间POP-Q各指示点及相关问卷评分比较,差异均无统计学意义(P＞0.05).23例压力性尿失禁与5例混合性尿失禁患者改良腹腔镜下阴道骶骨固定术同时行经闭孔无张力尿道中段悬吊带术者15例,未行者13例,两者术后尿失禁治愈率分别为14/15、10/13.结论 改良腹腔镜下阴道骶骨固定术主、客观治愈率高,不仅能达到解剖学复位,还能显著提高患者术后生命质量,术后疗效稳定.
目的 分析改良腹腔鏡下陰道骶骨固定術的臨床療效,評價其對盆腔器官脫垂治療的有效性和安全性.方法 迴顧性分析2008年1月至2012年9月在廣州醫科大學附屬第一醫院因盆腔器官脫垂行改良腹腔鏡下陰道骶骨固定術的66例患者的臨床資料,比較手術前、後盆腔器官脫垂定量(POP-Q)分度法各指示點位置,評價總體客觀治愈率及複髮率.通過盆底功能障礙性疾病癥狀問捲簡錶(PFDI-20)等相關問捲評分評價主觀治愈率以及術後尿失禁相關癥狀改善情況.結果 63例患者穫得6 ～57箇月的隨訪,中位隨訪時間16箇月,主觀治愈率95％ (60/63).術後POP-Q各指示點可達解剖複位,總體客觀治愈率90％ (57/63),總複髮率10％ (6/63).術後中位陰道長度為7.5 cm,較術前的8.0cm稍有縮短,兩者比較,差異有統計學意義(P＜0.01)；術後PFDI-20中位評分為21分,較術前的75分明顯改善,兩者比較,差異有統計學意義(P＜0.05)；術後隨訪＞3年、＞2～≤3年、＞1～≤2年、＞0.5～1年患者間POP-Q各指示點及相關問捲評分比較,差異均無統計學意義(P＞0.05).23例壓力性尿失禁與5例混閤性尿失禁患者改良腹腔鏡下陰道骶骨固定術同時行經閉孔無張力尿道中段懸弔帶術者15例,未行者13例,兩者術後尿失禁治愈率分彆為14/15、10/13.結論 改良腹腔鏡下陰道骶骨固定術主、客觀治愈率高,不僅能達到解剖學複位,還能顯著提高患者術後生命質量,術後療效穩定.
목적 분석개량복강경하음도저골고정술적림상료효,평개기대분강기관탈수치료적유효성화안전성.방법 회고성분석2008년1월지2012년9월재엄주의과대학부속제일의원인분강기관탈수행개량복강경하음도저골고정술적66례환자적림상자료,비교수술전、후분강기관탈수정량(POP-Q)분도법각지시점위치,평개총체객관치유솔급복발솔.통과분저공능장애성질병증상문권간표(PFDI-20)등상관문권평분평개주관치유솔이급술후뇨실금상관증상개선정황.결과 63례환자획득6 ～57개월적수방,중위수방시간16개월,주관치유솔95％ (60/63).술후POP-Q각지시점가체해부복위,총체객관치유솔90％ (57/63),총복발솔10％ (6/63).술후중위음도장도위7.5 cm,교술전적8.0cm초유축단,량자비교,차이유통계학의의(P＜0.01)；술후PFDI-20중위평분위21분,교술전적75분명현개선,량자비교,차이유통계학의의(P＜0.05)；술후수방＞3년、＞2～≤3년、＞1～≤2년、＞0.5～1년환자간POP-Q각지시점급상관문권평분비교,차이균무통계학의의(P＞0.05).23례압력성뇨실금여5례혼합성뇨실금환자개량복강경하음도저골고정술동시행경폐공무장력뇨도중단현조대술자15례,미행자13례,량자술후뇨실금치유솔분별위14/15、10/13.결론 개량복강경하음도저골고정술주、객관치유솔고,불부능체도해부학복위,환능현저제고환자술후생명질량,술후료효은정.
Objective To study clinical curative effect and complications of modified laparoscopic sacral colpopexy and evaluate the efficacy and safety of this procedure in treatment of pelvic organ prolapse (POP).Methods From Jan.2008 to Sept.2012,66 patients who had undergone modified laparoscopic sacral colpopexy for POP in the first affiliated hospital of Guangzhou medical university were studied retrospectively.Primary outcomes were assessed with POP quantitation (POP-Q) system that was measured before or after operation respectively to evaluate the objective cure rate and recurrence rate.Secondary outcomes were measured by the pelvic floor distress inventory short form (PFDI-20) to evaluate the subjective cure rate,as well as to evaluate the improvement of postoperative lower urinary tract symptoms.Results Sixty-three patients were followed up for 6 to 57 months,and the median follow-up time was 16 months,the overall objective cure rate was 95％ (60/63).Postoperative each indicator point was reset anatomically according to POP-Q,the overall objective cure rate was 90％ (57/63),and the total recurrence rate was 10％ (6/63).The median postoperative vaginal length was slightly shortened than preoperative length[7.5 cm versus 8.0 cm,P ＜ 0.01]; the median score of postoperative PFDI-20 was obviously improved compared to the preoperative (21 versus 75 scores,P ＜ 0.05) ; there was no statistically significant difference in POP-Q staging and questionnaire score at more than 3 years,＞ 2-≤ 3 years,＞1-≤2 years,＜0.5-1 year after operation(P ＞0.05).Among 23 patients with stress urinary incontinence (SUI) and 5 patients with mixed urinary incontinence (MUI),15 cases underwent transvaginal tension free vaginal tape-obturator (TVT-O) procedure simultaneously,13 cases did not.The cure rate of SUI was 14/15 and 10/13,respectively.Conclusions Modified laparoscopic sacral colpopexy can not only reach the anatomical replacement stage but significantly improve the postoperative quality of life with high subjective and objective cure rate and few complications.The long-term curative effect is stable.
