腹腔镜子宫切除阴道残端骶韧带悬吊的应用

Laparoscopic hysterectomy for vaginal stump sacral ligament suspension

摘要:

前瞻性的探究腹腔镜下全子宫切除术中阴道残端骶韧带悬吊对子宫良性肿瘤患者中术后盆底功能及生活质量的影响。方法?选取2014年1月-2015年6月来该院就诊的子宫良性肿瘤患者共98例，利用随机数表的方法将所有患者分为两组，分别为对照组和试验组，每组各49例。对照组采取常规腹腔镜子宫全切术，试验组采取阴道残端骶韧带悬吊式腹腔镜下全子宫切除术，比较两组患者手术时间、术中出血量。治疗后进行随访2年，通过比较两组患者术后6个月、术后12个月和术后2年盆底功能障碍问卷（PFDI-20）评分、阴道长度变化、性生活恢复情况以及阴道残端脱垂来判断临床疗效。结果?试验组患者手术时间与对照组相比差异无统计学意义（P?>0.05），但术中出血量明显低于对照组患者（P?<0.05）。对照组患者全部使用镇痛药，而试验组患者镇痛药使用率为91.84%，明显低于对照组（P?<0.05）。对照组阴道缩短长度为（2.11±0.97）cm，试验组为（1.05±0.74）cm，与对照组相比，试验组阴道缩短程度更小且差异有统计学意义（P?<0.05）；对照组性生活恢复时间为（71.33±10.32）d，试验组为（61.29±10.82）d，两组比较差异有统计学意义（P?<0.05）。治疗前两组患者PFDI-20评分差异无统计学意义，治疗后对照组术后6、12和24个月评分为（45.6±9.2）、（42.5±7.4）和（41.2±6.1）分，而试验组术后6、12和24个月PFDI-20评分分别为（41.3±8.4）、（36.8±4.9）和（32.8±6.7）分，试验组数据明显低于对照组数据（P?<0.05）。结论?腹腔镜下全子宫切除术时阴道残端预防性骶韧带悬吊可有效防止阴道残端脱垂，对盆底功能起到一定的支持作用，减少术后阴道缩短长度，有利于患者的预后，减少术中出血量。

Abstract:

To investigate the pelvic floor function, quality of life and impact on patients with benign uterine tumors after laparoscopic hysterectomy.?Method?98 cases of uterine benign tumor from January 2014 to June 2015 were selected by the method of random number table method, all patients were divided into control group and experimental group, 49 cases in each. The control group received conventional laparoscopic hysterectomy, and the experimental group was treated with vaginal stump suspension laparoscopic hysterectomy. The operation time and bleeding volume of the two groups were compared. Patients were followed up for 2 years. The PFDI-20 score, vaginal length changes, the recovery of sexual life and prolapse of vaginal stump to determine the clinical efficacy of 6 months, 12 months, and 24 months after surgery were compared.?Results?There was no significant difference in the operation time between the two groups (P?>?0.05); while the intraoperative blood loss of experimental group was significantly lower than that of the control group (P?