严红艳

【摘要】 目的：討论重度盆腔器官脱垂女性老年患者以阴道封闭术治疗的临床效果。方法：选取2017年12月-2018年12月笔者所在医院收治的60例重度盆腔器官脱垂女性老年患者，均接受阴道封闭术（全阴道封闭术/部分阴道封闭术）治疗。观察并发症发生情况、术后随访结果。结果：术后并发症发生率为3.33%。60例患者中，术前排尿困难31例，排便困难5例，压力性尿失禁17例;经手术治疗后，27例能自主顺利排尿，4例排便困难明显缓解，15例压力性尿失禁明显好转。术后随访1年，随访患者人数52例，失访8例。无一例复发，POP-Q分期Ⅰ期及以下，客观成功率100%。术后1年的阴裂长度、阴道长度均短于术前，且会阴体长度大于术前，差异均有统计学意义（P<0.05）。结论：重度盆腔器官脱垂女性老年患者以阴道封闭术治疗，可改善盆腔器官脱垂，缓解排尿排便困难，从而提高患者生活质量，并发症发生率、复发率均较低，是一项疗效稳定、安全的有效术式。

【关键词】 重度盆腔器官脱垂 全阴道封闭术 部分阴道封闭术

doi：10.14033/j.cnki.cfmr.2020.20.061 文献标识码 B 文章编号 1674-6805（2020）20-0-03

Analysis of the Clinical Effect of Vaginal Closure in Elderly Female Patients with Severe Pelvic Organ Prolapse/YAN Hongyan. //Chinese and Foreign Medical Research， 2020， 18（20）： -149

[Abstract] Objective： To investigate the clinical effect of vaginal closure in elderly female patients with severe pelvic organ prolapse. Method： From December 2017 to December 2018， 60 elderly female patients with severe pelvic organ prolapse admitted in our hospital were selected. All of them were treated with vaginal closure （total vaginal closure/partial vaginal closure）. The complications and postoperative follow-up results were observed. Result： The incidence of postoperative complications was 3.33%. Among the 60 patients， there were 31 cases of dysuria， 5 cases of dysdefecation and 17 cases of stress urinary incontinence before operation. After operation， 27 cases were able to urinate smoothly， 4 cases had obvious relief of dysdefecation， and 15 cases of stress urinary incontinence were significantly improved. After 1 year of postoperative follow-up， 52 patients were followed up and 8 cases were lost to follow-up. There was no recurrence. The POP-Q stage was stage Ⅰ and below， and the objective success rate was 100%. The length of vaginal fissure and the length of the vagina at 1 year after operation were shorter than those before operation， and the length of perineal body was larger than that before operation， the differences were statistically significant （P<0.05）. Conclusion： For elderly female patients with severe pelvic organ prolapse， vaginal closure can improve pelvic organ prolapse， relieve difficulty in urination and defecation， thus improving the quality of life of the patients. The incidence of complications and recurrence rate are low， and it is an effective operation with stable efficacy and safety.

[Key words] Severe pelvic organ prolapse Total vaginal closure Partial vaginal closure

First-authors address： Zhushan County Peoples Hospital， Zhushan 442200， China

盆腔器官脱垂是指各类因素引起盆底支持组织薄弱，导致女性盆腔器官下移，最后造成器官功能异常[1]。据不完全统计，我国盆腔器官脱垂发病率高达39%[2]。随着近年来我国人口老龄化问题日益严峻，盆腔器官脱垂女性老年患者数量不断增加，对其生活质量造成影响。妇科医生应充分评估与掌握该类患者的手术指征、可能面临的手术风险、手术结果。脱垂部位、脱垂程度、机体状况及有无性功能保留需求等因素均会对盆腔器官脱垂女性老年患者手术选择产生影响。由于该类患者年龄大、体质偏弱、合并症较多、手术耐受程度低，不适合进行盆腔器官脱垂盆腔重建术。……