阴道后壁桥式修补结合盆底筋膜缝合治疗阴道后壁缺陷的临床疗效观察
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摘要
目的分析阴道后壁桥式修补术结合盆底筋膜缝合治疗阴道后壁缺陷的效果,以及对患者性生活质量的影响,为改进后壁缺陷(阴道后壁脱垂)修补方法提供参考。方法采用回顾性研究,选择2016年3月至2017年2月华北石油总医院诊治的70例阴道后壁缺陷患者为研究对象。按照不同手术方式,将其分为观察组和对照组,每组35例患者。观察组患者行阴道后壁桥式修补结合盆底筋膜缝合;对照组行传统阴道后壁修补术。比较两组患者手术用时、术中出血量、住院时间;采用彭强器官脱垂尿失禁患者性生活调查表(PISQ-12)评估两组患者术前术后性生活质量,记录改善程度;随访1年,记录两组患者恢复情况、并发症发生率和1年复发率。结果①观察组患者手术用时、住院时间均短于对照组患者,术中出血量少于对照组患者,其差异均具有统计学意义(均P=0.0000)。②术前和术后3个月,两组患者PISQ-1评分差异无统计学意义(P>0.05);两组患者PISQ-1评分差值比较,其差异具有统计学意义(P=0.0000)。③两组患者均出现损伤,但随访期间愈合;两组术前便秘患者术后均有所改善且无严重便秘,对照组1例患者轻微尿失禁、阴道变短,观察组患者并发症发生率和1年复发率(5.7%、0%)低于对照组患者(22.9%、11.4%),其差异均具有统计学意义(均P<0.05)。结论阴道后壁桥式修补术结合盆底筋膜缝合能够有效治疗阴道后壁缺陷,改善便秘等症状;与传统术式相比,能够缩短手术用时,促进康复,减少并发症,降低1年复发率,值得推广应用。
Objective To analyze the effect of vaginal posterior wall bridge repair combined with pelvic floor fascia suture in the treatment of posterior vaginal wall defects, as well as the impact on the patient′s quality of life, to provide reference for the future improvement of the repair of posterior wall defects(vaginal posterior wall prolapse).Methods A retrospective study was conducted to select 70 patients with posterior vaginal wall defects admitted to the North China Petroleum General Hospital from March 2016 to February 2017. According to different surgical methods, they were divided into observation group and control group, with 35 patients in each group. Patients in the observation group underwent vaginal posterior wall bridge repair combined with pelvic floor fascia suture; the control group underwent conventional vaginal posterior wall repair. The time-consuming, blood loss and hospitalization time of the two groups were compared. The sexual life quality of the two groups of patients before and after surgery was evaluated by using the Peng Qeng organ prolapse urinary incontinence patient sexual life questionnaire(PISQ-12). After 1 year of follow-up, the recovery, complication rate and 1-year recurrence rate of the two groups were recorded. Results ①The patients in the observation group had shorter operation time and hospitalization time than the control group. The blood loss was less than that of the control group, and the difference was statistically significant(all P=0.0000).②There was no significant difference in PISQ-1 score between the two groups before and 3 months after operation(P>0.05). The difference of PISQ-1 scores between the two groups was statistically significant(P=0.0000).③Both groups of patients developed injury, but healed during follow-up; both groups of patients with preoperative constipation improved after surgery and no serious constipation, 1 patient in the control group had mild urinary incontinence, vaginal shortening, and complications occurred in the observation group. The rate and 1-year recurrence rate(5.7%, 0%) were lower than those in the control group(22.9%, 11.4%), and the differences were statistically significant(P<0.05).Conclusions Vaginal posterior wall bridge repair combined with pelvic floor fascia suture can effectively treat posterior vaginal wall defects and improve symptoms such as constipation; compared with traditional surgery, it can shorten the operation time, promote rehabilitation, reduce complications, and reduce the 1-year recurrence rate. It is worth promoting.
Objective To analyze the effect of vaginal posterior wall bridge repair combined with pelvic floor fascia suture in the treatment of posterior vaginal wall defects, as well as the impact on the patient′s quality of life, to provide reference for the future improvement of the repair of posterior wall defects(vaginal posterior wall prolapse).Methods A retrospective study was conducted to select 70 patients with posterior vaginal wall defects admitted to the North China Petroleum General Hospital from March 2016 to February 2017. According to different surgical methods, they were divided into observation group and control group, with 35 patients in each group. Patients in the observation group underwent vaginal posterior wall bridge repair combined with pelvic floor fascia suture; the control group underwent conventional vaginal posterior wall repair. The time-consuming, blood loss and hospitalization time of the two groups were compared. The sexual life quality of the two groups of patients before and after surgery was evaluated by using the Peng Qeng organ prolapse urinary incontinence patient sexual life questionnaire(PISQ-12). After 1 year of follow-up, the recovery, complication rate and 1-year recurrence rate of the two groups were recorded. Results ①The patients in the observation group had shorter operation time and hospitalization time than the control group. The blood loss was less than that of the control group, and the difference was statistically significant(all P=0.0000).②There was no significant difference in PISQ-1 score between the two groups before and 3 months after operation(P>0.05). The difference of PISQ-1 scores between the two groups was statistically significant(P=0.0000).③Both groups of patients developed injury, but healed during follow-up; both groups of patients with preoperative constipation improved after surgery and no serious constipation, 1 patient in the control group had mild urinary incontinence, vaginal shortening, and complications occurred in the observation group. The rate and 1-year recurrence rate(5.7%, 0%) were lower than those in the control group(22.9%, 11.4%), and the differences were statistically significant(P<0.05).Conclusions Vaginal posterior wall bridge repair combined with pelvic floor fascia suture can effectively treat posterior vaginal wall defects and improve symptoms such as constipation; compared with traditional surgery, it can shorten the operation time, promote rehabilitation, reduce complications, and reduce the 1-year recurrence rate. It is worth promoting.
引文
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[9] 苗娅莉,孙秀丽,杨欣,等.腹腔镜阴道骶骨固定术治疗盆腔器官脱垂的疗效评价[J].实用妇产科杂志,2017,33(2):105-109.
[10] 段磊,鲁永鲜,沈文洁,等.经阴道宫骶韧带高位悬吊术的远期疗效研究[J].中华妇产科杂志,2017,52(6):363-368.
[11] 孟津,金海红,王智文,等.腹腔镜改良阴道悬吊术治疗子宫切除术后阴道穹窿脱垂的研究[J].河北医药,2017,39(23):3579-3581,3584.
[12] 王夙斐,陈勇,王晓雯,等.网片对比骶棘韧带固定术治疗阴道顶端脱垂的系统评价[J].中国现代手术学杂志,2017,21(5):327-332.
[13] Teleman P,Laurikainen E,Kinne I,et al.Relationship between the pelvic organ prolapse quantification system (POP-Q),the pelvic floor impact questionnaire (PFIQ-7),and the pelvic floor distress inventory (PFDI-20) before and after anterior vaginal wall prolapse surgery[J].International Urogynecology Journal,2015,26(2):195-200.
[14] Endress Eva,Shek KL,Dietz HP,et al.Levator avulsion is not associated with symptom bother of female pelvic organ prolapse[J].Archives of Gynecology and Obstetrics,2015,292(3):629-633.
[15] Welk Blayne,Hana′a Al-Hothi,Jennifer Winick-Ng,et al.The effect of pelvic factures on future stress incontinence and pelvic organ prolapse surgery[J].International Urogynecology Journal,2015,26(6):805-811.
[16] 李芳兵,张丹丹,高琴,等.经阴道植入网片全盆底重建术治疗盆腔器官脱垂的疗效及对性功能的影响[J].中国性科学,2017,26(6):55-58.
[17] Farah Lone,Ranee Thakar,Abdul H Sultan,et al.One-year prospective comparison of vaginal pessaries and surgery for pelvic organ prolapse using the validated ICIQ-VS and ICIQ-UI (SF) questionnaires[J].International Urogynecology Journal,2015,26(9):1305-1312.
[18] Ghetti Chiara,Lee MinJae,Oliphant Sallie,et al.Sleep quality in women seeking care for pelvic organ prolapse[J].Maturitas,2014,80(2):155-161.
[19] 张小红,李秉枢,吴德斌,等.腹腔镜阴道/子宫骶骨固定术疗效及术后性功能的评价[J].武汉大学学报(医学版),2015,36(3):426-431.
[20] 黄仲禄,张勇,谢海容,等.腹腔镜下脱垂子宫腹壁线型悬吊固定术的临床研究[J].中国临床研究,2017,30(8):1084-1087.
[2] 李文娟,郑荦,王娜,等.“桥”式修补术治疗阴道前壁膨出的疗效分析[J].中国美容整形外科杂志,2015,26(1):40-43.
[3] 师亚娥,李小静.阴道前壁桥式缝合术治疗阴道前壁脱垂的临床效果分析[J].中国妇幼保健,2015,30(36):6613-6614.
[4] 於莉英,张桂宝,郑飞云,等.改良盆底重建术治疗盆腔器官脱垂的临床研究[J].现代妇产科进展,2015,21(2):112-115.
[5] 魏冬梅,王平,牛晓宇,等.腹腔镜下子宫/阴道-骶骨固定术与阴道网片全盆底重建术治疗盆腔器官脱垂的疗效比较[J].中华妇幼临床医学杂志(电子版),2015,11(2):37-42.
[6] 李顺双,纪妹.举宫杯辅助下腹腔镜骶骨阴道固定术与协和式全盆底重建术治疗盆腔器官脱垂的对比研究[J].实用妇产科杂志,2015,31(5):388-391.
[7] 赵有仙,吴大保.改良阴式子宫切除术治疗老年妇女子宫脱垂临床效果分析[J].中国妇幼保健,2015,30(16):2575-2577.
[8] 左欣,吴海峰,朱筱娟,等.阴式辅助下腹腔镜骶骨阴道固定术治疗重度盆腔器官脱垂的近期疗效[J].中国微创外科杂志,2016,16(12):1117-1120,1124.
[9] 苗娅莉,孙秀丽,杨欣,等.腹腔镜阴道骶骨固定术治疗盆腔器官脱垂的疗效评价[J].实用妇产科杂志,2017,33(2):105-109.
[10] 段磊,鲁永鲜,沈文洁,等.经阴道宫骶韧带高位悬吊术的远期疗效研究[J].中华妇产科杂志,2017,52(6):363-368.
[11] 孟津,金海红,王智文,等.腹腔镜改良阴道悬吊术治疗子宫切除术后阴道穹窿脱垂的研究[J].河北医药,2017,39(23):3579-3581,3584.
[12] 王夙斐,陈勇,王晓雯,等.网片对比骶棘韧带固定术治疗阴道顶端脱垂的系统评价[J].中国现代手术学杂志,2017,21(5):327-332.
[13] Teleman P,Laurikainen E,Kinne I,et al.Relationship between the pelvic organ prolapse quantification system (POP-Q),the pelvic floor impact questionnaire (PFIQ-7),and the pelvic floor distress inventory (PFDI-20) before and after anterior vaginal wall prolapse surgery[J].International Urogynecology Journal,2015,26(2):195-200.
[14] Endress Eva,Shek KL,Dietz HP,et al.Levator avulsion is not associated with symptom bother of female pelvic organ prolapse[J].Archives of Gynecology and Obstetrics,2015,292(3):629-633.
[15] Welk Blayne,Hana′a Al-Hothi,Jennifer Winick-Ng,et al.The effect of pelvic factures on future stress incontinence and pelvic organ prolapse surgery[J].International Urogynecology Journal,2015,26(6):805-811.
[16] 李芳兵,张丹丹,高琴,等.经阴道植入网片全盆底重建术治疗盆腔器官脱垂的疗效及对性功能的影响[J].中国性科学,2017,26(6):55-58.
[17] Farah Lone,Ranee Thakar,Abdul H Sultan,et al.One-year prospective comparison of vaginal pessaries and surgery for pelvic organ prolapse using the validated ICIQ-VS and ICIQ-UI (SF) questionnaires[J].International Urogynecology Journal,2015,26(9):1305-1312.
[18] Ghetti Chiara,Lee MinJae,Oliphant Sallie,et al.Sleep quality in women seeking care for pelvic organ prolapse[J].Maturitas,2014,80(2):155-161.
[19] 张小红,李秉枢,吴德斌,等.腹腔镜阴道/子宫骶骨固定术疗效及术后性功能的评价[J].武汉大学学报(医学版),2015,36(3):426-431.
[20] 黄仲禄,张勇,谢海容,等.腹腔镜下脱垂子宫腹壁线型悬吊固定术的临床研究[J].中国临床研究,2017,30(8):1084-1087.