吴艳霞，张蕾，刘荣娜

全盆底重建术与传统阴式修补术治疗老年女性盆腔器官脱垂的远期疗效研究

吴艳霞，张蕾，刘荣娜

目的：比较全盆底重建术与传统阴式修补术治疗老年女性盆腔器官脱垂（POP）的临床效果以及对远期生活质量的影响。方法：选择2008年2月—2009年2月在中国人民解放军白求恩国际和平医院妇产科进行手术治疗且完成随访的盆腔器官脱垂患者60例，年龄≥55岁，均为绝经后妇女，POP-Q分期为Ⅲ～Ⅳ期。采用网片进行全盆底重建术的30例患者为观察组，采用传统的经阴道全子宫切除术加阴道前后壁修补术的30例患者为对照组。术后5年内定期门诊随访，以POP-Q判断术后疗效，盆底不适调查表简表（PFDI-20）评价术后患者生活质量。结果：观察组和对照组的手术时间［（107.83±13.00）min vs.（127.50±13.25）min］，术中出血量［（194.67±21.13）mL vs.（220.67±28.15）mL］，住院总费用［（32 488.38±3 408.43）元vs.（13 811.41±2 634.89）元］相比，差异均有统计学意义（P＜0.05）。术后POP-Q重新评分，至术后5年，观察组有1例复发至Ⅱ度，对照组5例复发。2组患者术后1，6个月的PFDI-20评分相比差异无统计学意义（P＞0.05），而观察组术后1，2，5年的PFDI-20评分低于对照组，差异有统计学意义（均P＜0.05）。结论：与传统经阴道子宫切除术加阴道前后壁修补术相比，全盆底重建术术后复发率低，生活质量改善明显，但费用较高。

盆腔脏器脱垂；子宫切除术，阴道式；对照组；治疗结果；生活质量

【Abstract】Objective:To compare the clinical effects and long-period life quality between total pelvic floor reconstruction and transvaginal hysterectomy with vaginal anterior and posterior wall repair in older women with pelvic organ prolapse（POP）. Methods：From February 2008 to February 2009，sixty POP patients were reviewed in our study whose age was over 55 years old. They were all postmenopausal women and POP-Q were stageⅢ-Ⅳ.The study group contain of 30 cases used the mesh of total pelvic floor reconstruction，and the control group adopted conventional surgical transvaginal hysterectomy with vaginal anterior and posterior wall repair in 30 patients.We regular followed up all women last 5 years in outpatient by POP-Q and questionnaire （PFDI-20）which were used to evaluate the life quality.Results：In the study group and the control group，operation time［（107.83±13.00）min vs.（127.50±13.25）min］，bleeding［（194.67±21.13）mL vs.（220.67±28.15）mL］，total cost of hospitalization［（32 488.38±3 408.43）¥vs.（13 811.41±2 634.89）¥］，had statistical significances（P＜0.05）.There was 1 case recurrence toⅡstage in the study group and 5 cases in the control group by POP-Q score postoperative 5 years.Postoperative 5 years，PFDI-20 scores in the two groups were compared，there were no statistical significance after 1，6 months opposite.There were statistical significance after 1，2，5 years，the women had lower scores and higher quality of life in the study group.Conclusions：The total pelvic floor reconstruction was lower recurrence rate，higher quality of life and cost more than the traditional vaginal hysterectomy with vaginal anterior and posterior wall repair in older women with pelvic organ prolapse.

【Keywords】Pelvic organ prolapse；Hysterectomy，transvaginal；Control groups；Treatment outcome；Quality of life

（J Int Obstet Gynecol，2015，42：437-440）

盆腔器官脱垂（pelvic organ prolapse，POP）虽非致命性疾病，却严重影响女性的生活质量，近几年越来越受到研究者的重视。现代解剖学腔室理论在垂直方向上将盆底分为前、中、后3个腔室［1］，应用网片的全盆底重建术和传统经阴道子宫全切术加阴道前后壁修补术相当于对盆底的3个腔室全部进行修补。……