阴式手术治疗盆腔脏器脱垂的回顾性分析

Retrospective analysis of operation per vagina on pelvic organ prolapse

关键词:  阴式手术  盆腔脏器脱垂  盆底重建  尿失禁

Key words:  surgery per vagina  pelvic organ prolapse  pelvic floor reconstruction operation  urinary incontinence

摘要:

［目的］探讨盆底重建手术（传统与新式）治疗盆腔脏器脱垂的效果以及术后复发的危险因素。［方法］对大连医科大学附属第一医院2005年7月～2008年6月因Ⅱ度及以上盆腔脏器脱垂行首次手术治疗的91例病例进行回顾分析及随访。问卷调查主观症状治愈、手术前后尿失禁及性生活影响情况,依据POP-Q（Pelvic Organ Prolapse Quantification）评分判定客观治愈情况。［结果］①手术时间平均1.5 h，术中出血平均45 mL，术后住院平均6.5 d。传统手术主、客观治愈率分别为93.3% （56/60）、83.3%（50/60）。新式手术主、客观治愈率分别为96.8% （30/31）、77.4%（24/31）。②传统与新式手术单纯前、后壁膨出及同时复发率分别为25% （15/60）、6.5%（2/31），因复发二次手术分别为1.7%（1/60）、0。复发率差异有统计学意义（P<0.05）。③原有尿失禁患者60.0%（15/25）症状消失,20.0%（5/25）加重。性功能改善者33.0%（30/91），无明显变化56.0%（51/91），减弱11.0%（10/91）。［结论］阴式手术治疗Ⅱ度及以上盆腔脏器脱垂手术时间短，术中出血少，恢复快，主、客观治愈率高，对尿失禁有明显改善。另外，新式手术术后复发率低、对尿失禁改善率更高，其复发与阴道分娩次数及病程长短相关。

Abstract:

［Objective］ To study the result of pelvic floor reconstruction operations, including traditional operation and new-style operation on pelvic organ prolapse in our hospital, and to discuss postoperative recurrent risk factors. ［Methods］ Sixty traditional primary operations, such as hesteretomy per vagina+colporrhaphia anterior-posterior and thirty-one new style primary one, such as hesterectomy per vagina+colporrhaphia anterior-posterior with patch, posterior bridge-style hesterectomy, ventrafixation and paravaginal neoplasty in 91 patients with pelvic organ II-grade and above prolapse from July 2005 to June 2008 were retrospectively analyzed and followed up. Questionnaire was applied to know therapeutic results of subjective symptom, urinary incontinence and sexual intercourse and comparison of these to pre-operative one. POP-Q, Pelvic Organ prolapse Quantification was used to judge objective therapy circumference. ［Result］ 1. There was short surgery time (average 1.5 hours) and little bleeding (average 45ml), and fast recovery (6.5 days). Subject recovery rate of traditional operations and new-style ones was 93.3% (56/60) and 96.8% (30/31) respectively. Object recovery rate was 83.3% (50/60) and 77.4% (24/31) respectively. 2. Recurrence circumference: recurrence rate of traditional operations and new-style ones were respectively 25% (15/60) and 6.5% (2/31). There was significant difference between them (P<0.05). 3. Improvement of urinary incontinence and sexual function. Twenty-five cases of urinary incontinence had improvement (traditional surgery: 13 cases and new-style one: 12 cases), Sixty percent (15/25) patients who had of urinary incontinence came back to normal. Twenty percent (5/25) (traditional surgery: 26.7% (4/15) and new-style one: 10% (1/10)) had more serious urinary incontinence. Four and point five percent (3/66) of patients showed urinary incontinence after operation. Thirty-three percent (30/91) had improvement of sexual function. Fifty-six percent (51/91) had no marked change. Eleven percent (10/91) had decreased sexual function. ［Conclusion］ Surgery per vagina shows short surgery time, less bleeding, fast recovery, high subject recovery rate and urinary incontinence improving for POP. Furthermore, new-style surgery has lower recurrence rate and higher improvement rate on urinary incontinence and booster life quality of patients. Its recurrence is not relevant with age, menopause time limit, grade of prolapse or whether the patient has chronic cough or not, but relevant with frequency of vaginal delivery and course of the disease.