保留子宫的经阴道骶棘韧带悬吊术治疗中重度盆腔器官脱垂患者的效果研究

Effect of vaginal sacrospinous ligament suspension with uterus preservation in treatment of patients with moderate to severe pelvic organ prolapse

  • 摘要:
    目的 探讨保留子宫的经阴道骶棘韧带悬吊术(VSSLS)治疗中重度盆腔器官脱垂(POP)的效果。
    方法 将92例中重度POP患者随机分为对照组和观察组,每组46例。对照组接受阴道前后壁修补术(VAPWR)治疗,观察组接受VSSLS治疗。比较2组术中出血量、手术时间、住院时间; 应用盆底功能障碍量表(PFDI-20)评价生活质量; 应用盆底器官脱垂/尿失禁性功能量表(PISQ-12)评估性生活满意度、性行为疼痛、性行为频率、性行为的感知控制情况; 记录2组手术并发症发生情况。
    结果 观察组术中出血量、手术时间及住院时间少于、短于对照组,差异有统计学意义(P < 0.01)。治疗后,观察组PFDI-20各维度评分均低于对照组,治疗前后各维度评分下降幅度大于对照组,差异均有统计学意义(P < 0.01)。治疗后,观察组性生活满意度、性行为频率及性行为的感知控制得分高于对照组,上述指标治疗前后变化幅度大于对照组,性行为疼痛得分低于对照组,性行为疼痛下降幅度大于对照组,差异均有统计学意义(P < 0.01)。观察组并发症发生率低于对照组,差异有统计学意义(P < 0.01)。
    结论 VSSLS作为一种治疗中重度POP的手术方式,可以显著改善患者的生活质量。

     

    Abstract:
    Objective To explore the effect of vaginal sacrospinous ligament suspension (VSSLS) with uterus preservation in treatment of patients with moderate to severe pelvic organ prolapse (POP).
    Methods A total of 92 patients with moderate to severe POP were randomly divided into control group and observation group, with 46 cases in each group. The control group received vaginal anterior and posterior wall repair (VAPWR), while the observation group underwent VSSLS. The intraoperative blood loss, operation time and hospital stay were compared between the two groups; the Pelvic Floor Distress Inventory-20 (PFDI-20) was used to evaluate quality of life; the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) was used to assess conditions of sexual satisfaction degree, dyspareunia, sexual frequency, and perceived control during sexual activity; surgical complications in both groups were recorded.
    Results The observation group had less intraoperative blood loss, shorter operation time, and shorter hospital stay compared with the control group (P < 0.01). After treatment, the observation group had lower scores in all dimensions of the PFDI-20 compared with the control group, and the decreasing range was significantly greater than that in the control group (P < 0.01). After treatment, the observation group had significant higher scores for sexual satisfaction degree, sexual frequency and perceived control during sexual activity compared with the control group, and the change in these indicators before and after treatment was also significantly greater in the observation group, while the score for dyspareunia was significantly lower in the observation group, with a significant decrease compared with the control group (P < 0.01). The incidence of complications was significantly lower in the observation group than that in the control group (P < 0.01).
    Conclusion As a surgical approach for the treatment of moderate to severe POP, VSSLS can significantly improve patient's quality of life.

     

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