[1]杜昕,秦海霞,王世进,等.腹腔镜下髂耻韧带悬吊术与经阴道骶棘韧带悬吊术治疗中盆腔器官脱垂疗效比较[J].新乡医学院学报,2023,40(9):860-866.[doi:10.7683/xxyxyxb.2023.09.011]
　DU Xin,QIN Haixia,WANG Shijin,et al.Comparison of therapeutic effects of laparoscopic pectopexy and vaginal sacrospinous ligament fixation in the treatment of middle pelvic organ prolapse[J].Journal of Xinxiang Medical University,2023,40(9):860-866.[doi:10.7683/xxyxyxb.2023.09.011]
点击复制

腹腔镜下髂耻韧带悬吊术与经阴道骶棘韧带悬吊术治疗中盆腔器官脱垂疗效比较
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年9
页码:
860-866
栏目:
临床研究
出版日期:
2023-09-05

文章信息/Info

Title:
Comparison of therapeutic effects of laparoscopic pectopexy and vaginal sacrospinous ligament fixation in the treatment of middle pelvic organ prolapse
作者:
杜昕; 秦海霞; 王世进; 朱利红; 尹希瑶; 赵昊斌; 张灿
（新乡医学院第一附属医院妇产科，河南　卫辉　453100）
Author(s):
DU Xin; QIN Haixia; WANG Shijin; ZHU Lihong; YIN Xiyao; ZHAO Haobin; ZHANG Can
( Department of Obstetrics and Gynecology，the First Affiliated Hospital of Xinxiang Medical University，Weihui 453100，Henan Province，China)
关键词:
盆腔器官脱垂; 腹腔镜髂耻韧带悬吊术; 经阴道骶棘韧带固定术
Keywords:
pelvic organ prolapse; laparoscopic pectopexy; vaginal sacrospinous ligament fixation
分类号:
R711
DOI:
10.7683/xxyxyxb.2023.09.011
文献标志码:
A
摘要:
目的　比较腹腔镜下髂耻韧带悬吊术（LP）与经阴道骶棘韧带固定术（VSSLF）治疗中盆腔器官脱垂的临床疗效。
方法　选择2020年9月至2021年9月新乡医学院第一附属医院收治的87例中盆腔器官脱垂患者为研究对象，根据手术方式将患者分为LP组（n=45）和VSSLF组（n=42）。记录并比较2组患者的手术时间、术中出血量、术后留置尿管时间、残余尿量、术后住院时间、住院费用。于术后6个月和术后1 a评估2组患者的临床疗效，并计算治愈率和复发率。根据盆腔脏器脱垂定量（POP-Q）测量指示点Aa、Ba、C、Ap、Bp点位置及阴道总长度（TVL）。术前、术后6个月及术后1 a，采用盆底功能障碍性疾病症状问卷-20(PFDI-20)和盆底器官脱垂影响问卷-7(PFIQ-7)评估2组患者的生活质量。术前及术后1 a，采用盆腔器官脱垂尿失禁性生活问卷-12(PISQ-12)评估 2组患者的性生活质量。术后1 a内每个月对患者进行随访，了解患者并发症发生情况。
结果　2组患者手术时间、术后留置尿管时间、残余尿量及术后住院时间比较差异无统计学意义（P>0.05）；LP组患者术中出血量显著低于VSSLF组（P<0.05）；LP组患者住院费用显著高于VSSLF组（P<0.05）。术后6个月，VSSLF组与LP组患者的复发率和治愈率比较差异无统计学意义（P>0.05）；术后1 a， VSSLF组患者的复发率显著高于LP组，治愈率显著低于LP组（P<0.05）。术前、术后6个月及术后1 a，LP组与VSSLF组患者的Aa、Ba、C、Ap、Bp指示点测量值及TVL比较差异无统计学意义（P>0.05）；2组患者术后6个月和术后1 a的Aa、Ba、C、Ap、Bp指示点测量值均显著低于术前（P<0.05）； 2组患者术后6个月与术后1 a的Aa、Ba、C、Ap、Bp指示点测量值比较差异无统计学意义（P>0.05）； 2组患者术前、术后6个月及术后1 a的TVL组内两两比较差异均无统计学意义（P>0.05）。术前、术后6个月及术后1 a，LP组与VSSLF组患者的PFDI-20、PFIQ-7评分比较差异无统计学意义（P>0.05）； 2组患者术后6个月、术后1 a的PFDI-20、PFIQ-7评分均显著低于术前(P<0.05)； 2组患者术后1 a 的PFDI-20、PFIQ-7评分与术后 6 个月比较差异无统计学意义(P>0.05)。 术后1 a，LP组40例和VSSLF组38例患者完成PSIQ-12调查；术前及术后1 a，LP组与VSSLF组患者的PSIQ-12评分比较差异无统计学意义（P>0.05）； 2组患者术后1 a 的PSIQ-12评分均显著高于术前 (P<0.05)。术后1 a，LP组和VSSLF组患者的并发症发生率分别为4.4%（2/45）和7.1%（3/42），2组患者的并发症发生率比较差异无统计学意义（χ2=0.661，P>0.05）。
结论　LP和VSSLF治疗中盆腔器官脱垂均可明显改善患者生活质量，患者术后均能获得良好的解剖复位；且LP具有术中出血量少、复发率低等优势。
Abstract:
Objective　To compare the clinical efficacy of laparoscopic pectopexy (LP) and vaginal sacrospinous ligament fixation (VSSLF) in the treatment of middle pelvic organ prolapse.
Methods　A total of 87 patients with middle pelvic organ prolapse admitted to the First Affiliated Hospital of Xinxiang Medical University from September 2020 to September 2021 were selected as the research objects,and the patients were divided into LP group（n=45）and VSSLF group（n=42）according to the operative method.The operation time,intraoperative blood loss,postoperative indwelling catheter time,residual urine volume,postoperative hospital stay time and hospitalization expense were recorded and compared between the two groups.The clinical efficacy of patients in the two groups was evaluated at 6 months and 1 year after surgery,and the cure rate and recurrence rate were caculated.The location of indication points Aa,Ba,C,Ap,Bp and total vaginal length (TVL) were measured according to the pelvic organ prolapsed quantitation (POP-Q).Before surgery,6 months after surgery and 1 year after surgery,the quality of life of patients in the two groups was evaluated by the pelvic floor distress inventory-short form-20 (PFDI-20) and pelvic floor impact questionnaire-7 (PFIQ-7).The quality of sexual life of patients in the two groups was evaluated by the pelvic organ prolapse-urinary incontinence sexual qustionnaire-12 (PISQ-12) before surgery and 1 year after surgery.The patients were followed up every month within 1 year after surgery to understand the incidence of complications.
Results　There was no significant difference in operation time,postoperative indwelling catheter time,residual urine volume and postoperative hospital stay time of patients between the two groups (P>0.05)；the intraoperative bleeding volume of patients in the LP group was significantly lower than that in the VSSLF group (P<0.05)；the hospitalization expense of patients in the LP group was significantly higher than that in the VSSLF group (P<0.05).At 6 months after surgery,there was no significant difference in the recurrence rate and cure rate between the VSSLF group and the LP group (P>0.05)；at 1 year after surgery,the recurrence rate of patients in the VSSLF group was significantly higher than that in the LP group,and the cure rate was significantly lower than that in the LP group (P<0.05).There was no significant difference in the measurement values of Aa,Ba,C,Ap,Bp indicator points and TVL between the LP group and the VSSLF group before surgery,6 months after surgery and 1 year after surgery (P>0.05)；the measurement values of Aa,Ba,C,Ap,and Bp indicator points of patients in the two groups at 6 months and 1 year after surgery were significantly lower than those before surgery (P<0.05)；there was no significant difference in the measurement values of Aa,Ba,C,Ap and Bp indicator points of patients in the two groups between 6 months after surgery and 1 year after surgery (P>0.05)；there was no significant difference in pairwise comparisons of TVL of patients in the two groups before surgery,6 months after surgery and 1 year after surgery (P>0.05).There was no significant difference in the PFDI-20 and PFIQ-7 scores of patients between the LP group and the VSSLF group before surgery,6 months after surgery,and 1 year after surgery (P>0.05)；the PFDI-20 and PFIQ-7 scores of patients in the two groups at 6 months after surgery and 1 year after surgery were significantly lower than those before surgery (P<0.05)；there was no significant difference in the PFDI-20 and PFIQ-7 scores of patients in the two groups between 1 year after surgery and 6 months after surgery (P>0.05).At one year after surgery,40 patients in the LP group and 38 patients in the VSSLF group completed PSIQ-12 surveys；there was no significant difference in PSIQ-12 scores between the LP group and the VSSLF group before surgery and 1 year after surgery (P>0.05)；the PSIQ-12 score of patients in the two groups at one year after surgery was significantly higher than that before surgery (P<0.05).The incidence of complications of patients in the LP group and VSSLF group was 4.4% (2/45) and 7.1% (3/42),respectively at one year after surgery.There was no significant difference in the incidence of complications of patients between the two groups (χ2=0.661,P>0.05).
Conclusion　Both LP and VSSLF can significantly improve the quality of life of patients with middle pelvic organ prolapse,and patients can obtain good anatomical reduction after surgery；and LP has advantages such as low intraoperative bleeding and low recurrence rate.

参考文献/References:

［1］　FRIEDMAN T,ESLICK G D,DIETZ H P.Risk factors for prolapse recurrence:systematic review and meta-analysis［J］.Int Urogynecol J,2018,29(1):13-21.
［2］　中华医学会妇产科学分会妇科盆底学组．盆腔器官脱垂的中国诊治指南(2020 年版)［J］.中华妇产科杂志,2020,55(5):300-306.
PELVIC FLOOR GROUP OF GYNECOLOGY AND OBSTETRICS SOCIETY,CHINESE MEDICAL ASSOCIATION.Chinese guideline for the diagnosis and management of pelvic orang prolapse (2020 version)［J］.Chin J Obstet Gynecol,2020,55(5):300-306.
［3］　DELANCEY J O．Anatomy and biomechanics of genital prolapse［J］．Clin Obstet Gynecol,1993,36(4):897-909.
［4］　MACHER C,FEINER B,BAESSLER K,et al.Surgery for women with apical vaginal prolapse［J］.Cochrane Database Syst Rev,2016,10(10):CD012376.
［5］　WHITEHEAD W E,BRADLEY C S,BROWN M B,et al.Gastrointestinal complications following abdominal sacrocolpopexy for advanced pelvic organ prolapse［J］.Am J Obstet Gynecol,2007,197(1):78.e1-78.e787.
［6］　张体硕,王玲,田笛,等.腹腔镜髂耻韧带悬吊术在治疗盆腔器官脱垂中的研究进展［J］.国际妇产科学杂志,2019,46(6):605-608.
ZHANG T S,WANG L,TIAN D,et al.Advances of laparoscopic pectopexy in the treatment of pelvic organ prolapse［J］．Int J Gynaecol Obstet,2019,46(6):605-608.
［7］　MACCRAITH E,CUNNANE E M,JOYCE M,et al.Comparison of synthetic mesh erosion and chronic pain rates after surgery for pelvic organ prolapse and stress urinary incontinence:a systematic review［J］．Int Urogynecol J,2021,32(3):573-580.
［8］　GRIGORIADIS T,ATHANASIOU S,GIANNOULIS G,et al．Translation and psychometric evaluation of the Greek short forms of two condition-specific quality of life questionnaires for women with pelvic floor disorders:PFDI-20 and PFIQ-7［J］．Int Urogynecol J,2013,24(12) :2131-2144.
［9］　田甜,刘翔宇,殷广洁,等.应用Mersilene带行改良的腹腔镜髂耻韧带固定术治疗中盆腔器官脱垂的短期疗效评价［J］.现代妇产科进展,2022,31(5):336-340.
TIAN T,LIU X Y,YIN G J,et al.Short-term efficacy evaluation of modified pectopexy with Mersilene tape in the treatment of mipelvic organ prolapse［J］.Prog Obstet Gynecol,2022,31(5):336-340.
［10］　中华医学会妇产科分会妇科盆底学组．腹腔镜子宫或阴道骶骨固定术专家共识［J］.中华妇产科杂志,2014,49(8):573-575.
PELVIC FLOOR GROUP OF GYNECOLOGY AND OBSTETRICS SOCIETY,CHINESE MEDICAL ASSOCIATION.Expert consensus on laparoscopic sacral colpopexy［J］.Chin J Obstet Gynecol,2014,49(8):573-575.
［11］　郭祥翠,王倩青,李力,等．经脐单孔腹腔镜髂耻韧带固定术与阴道骶骨固定术治疗女性盆腔器官脱垂疗效比较［J］.新乡医学院学报,2021,38(10):930-934.
GUO X C,WANG Q Q,LI L,et al.Comparison of the curative effect between transumbilical single-incision laparoscopic sacrolpopexy in the treatment of female pelvic organ prolapse［J］．J Xinxiang Med Univ,2021,38(10):930-934.
［12］　SEDERL J.Surgery in prolapse of a blind-end vagina［J］．Geburtshilfe Frauenheilkd,1958,18(6):824-828.
［13］　PETROS P E,WOODMAN P J.The integral theory of continence［J］.Int Urogynecol J Pelvic Floor Dysfunct,2008,19(1):35-40.
［14］　GEOFFRION R,HYAKUTAKE M T,KOENIG N A,et al.Bilateral sacrospinous vault fixation with tailored synthetic mesh arms:clinical outcomes at one year［J］.J Obstet Gynaecol Can,2015,37(2):129-137.
［15］　MORGAN D M,LARSON K.Uterosacral and sacrospinous ligament suspension for restoration of apical vaginal support［J］.Clin Obstet Gynecol,2010,53(1):72-85.
［16］　BURCH J C.Urethrovaginal fixation to Cooper′s ligament for correction of stress incontinence,cystocele,and prolapse［J］.Am J Obstet Gynecol,1961,81:281-290.
［17］　COSSON M,BOUKERROU M,LACAZE S,et al．A study of pelvic ligament strength［J］．Eur J Obstet Gynecol Reprod Biol,2003,109(1):80-87.
［18］　NO K G,SCHIERMEIER S,ALKATOUT I,et al.Laparoscopic pectopexy：a prospective,randomized,comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy- postoperative results and intermediate-term follow-up in a pilot study［J］.J Endourol,2015,29(2):210-215.
［19］　赵成志,卢深涛,王荥,等．腹腔镜骶骨固定术相关并发症的回顾:7年单中心临床分析［J］．中华腔镜外科杂志(电子版),2020,13(4):223-228.DOI:10.3877/cma.j.issn.1674-6899.2020.04.007.
ZHAO C Z,LU S T,WANG Y,et al．Complications associated with laparoscopic sacral fixation：a 7-year single center clinical analysis［J］．Chin J Laparoscopic Surgery (Electr Ed),2020,13(4):223-228.DOI:10.3877/cma.j.issn.1674-6899.2020.04.007.
［20］　BANERJEE C,NO K G.Laparoscopic pectopexy：a new technique of prolapse surgery for obese patients［J］.Arch Gynecol Obstet,2011,284(3):631-635.
［21］　KALE A,BILER A,TERZI H,et al.Laparoscopic pectopexy:initial experience of single center with a new technique for apical prolapse surgery［J］.Int Braz J Urol,2017,43(5):903-909．
［22］　BILER A,ERTAS I E,TOSUN G,et al．Perioperative complications and short-term outcomes of abdominal sacrocolpopexy,laparoscopic sacrocolpopexy,and laparoscopic pectopexy for apical prolapse［J］．Int Braz J Urol,2018,44(5):996-1004.
［23］　施素华,周毅惠,丁华峰,等．腹腔镜下髂耻韧带固定术治疗盆腔脏器脱垂［J］．中国微创外科杂志,2019,19(1):34-38.
SHI S H,ZHOU Y H,DING H F,et al．Laparoscopic pectopexy in the treatment of pelvic organ prolapse［J］．Chin J Min Inv Surg,2019,19(1):34-38.
［24］　LI-YUN-FONG R J,LAROUCHE M,HYAKUTAKE M,et al.Is pelvic floor dysfunction an independent threat to sexual function? A cross-sectional study in women with pelvic floor dysfunction［J］.J Sex Med,2017,14(2):226-237.
［25］　TAHAOGLU A E,BAKIR M S,PEKER N,et al．Modified laparoscopic pectopexy:short-term follow-up and quality of life［J］．Int Urogynecol J,2018,29(8):1155-1160.
［26］　SIDDLE N,SARREL P,WHITEHEAD M.The effect of hysterectomy on the age at ovarian failure:identification of a subgroup of women with premature loss of ovarian function and literature review［J］.Fertil Steril,1987,47(1):94-100.

相似文献/References:

[1]何永娜.盆腔器官脱垂复位术中行抗尿失禁术治疗隐匿性压力性尿失禁效果分析[J].新乡医学院学报,2015,32(12):1115.
[2]李宇琪,刘海意,吴媛媛,等.生物反馈联合电刺激和Kegel训练治疗产后盆底功能障碍性疾病疗效观察[J].新乡医学院学报,2017,34(7):619.[doi:10.7683/xxyxyxb.2017.07.017]
　LI Yu-qi,LIU Hai-yi,WU Yuan-yuan,et al.Effect of biofeedback combined with electrical stimulation and Kegel training in the treatment of postpartum pelvic floor dysfunction[J].Journal of Xinxiang Medical University,2017,34(9):619.[doi:10.7683/xxyxyxb.2017.07.017]
[3]郭晓晗,谢瑜娟,秦博,等.超声检查腹直肌分离度及肛提肌裂孔长度和面积对初产妇盆腔器官脱垂的评估作用[J].新乡医学院学报,2023,40(3):238.[doi:10.7683/xxyxyxb.2023.03.008]
　GUO Xiaohan,XIE Yujuan,QIN Bo,et al.Value of ultrasound examination of diastasis recti abdominis and the length and area of levator hiatus in evaluating the pelvic organ prolapse in primipara[J].Journal of Xinxiang Medical University,2023,40(9):238.[doi:10.7683/xxyxyxb.2023.03.008]

更新日期/Last Update: 2023-09-05