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  • 戴志远,舒慧敏,孙 静,等.子宫锥辅助下腹腔镜阴道骶骨固定术治疗重度盆腔器官脱垂疗效分析[J].同济大学学报(医学版),2019,30(3):343-348.    [点击复制]
  • DAI Zhi-yuan,SHU Hui-min,SUN Jing,et al.Modified laparoscopic sacrocolpopexy for treating severe pelvic organ prolapse[J].同济大学学报(医学版),2019,30(3):343-348.   [点击复制]
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子宫锥辅助下腹腔镜阴道骶骨固定术治疗重度盆腔器官脱垂疗效分析
戴志远,舒慧敏,孙静,丁慧
0
(同济大学附属第一妇婴保健院妇科,上海 200040)
摘要:
目的 评价在自主研发子宫锥辅助下行腹腔镜阴道骶骨固定术治疗重度盆腔器官脱垂的疗效。方法 2014年6月—2018年8月在同济大学附属第一妇婴保健院对52例重度子宫脱垂伴有不同程度阴道前后壁膨出的患者,用自主研发子宫锥辅助行腹腔镜下自制“Y”型聚丙烯网片阴道骶骨固定术。记录手术时间、出血量,采用盆腔器官脱垂定量分度法(POP-Q)评估各点位置,通过盆底功能障碍性疾病症状问卷简表(PFDI-20)、盆底疾病生活质量影响问卷(I-QOL)及术后尿失禁相关症状改善情况盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12),评价客观治愈率及主观治愈率。结果 52例患者手术顺利,术中无盆腔器官损伤及大出血等并发症,手术时间为(148.3±32.0)min,出血量为(61.3±46.2)mL。52例获得15~40个月的随访,中位随访时间22.5个月,术后POP-Q各指示点(Aa, Ba, C, Ap, Bp)可达解剖复位(P<0.001),无手术失败,术后复发2例。主观治愈率为94.2%,客观治愈率96.2%,3例患者术后出现新发尿失禁,2例患者(3.8%)发生阴道顶端网片暴露,术前、术后PFDI-20及PISQ-12两者比较,差异有统计学意义(P<0.05)。结论 腹腔镜阴道骶骨固定术主、客观治愈率高,子宫锥辅助能够使手术视野暴露更清晰、缩短手术时间、降低术中术后并发症、使解剖学复位更好。
关键词:  盆腔器官脱垂  阴道骶骨固定术  辅助器械  腹腔镜
DOI:10.16118/j.1008-0392.2019.03.015
投稿时间:2018-09-14
基金项目:上海市科学技术委员会资助项目(17411967900,18411963900)
Modified laparoscopic sacrocolpopexy for treating severe pelvic organ prolapse
DAI Zhi-yuan,SHU Hui-min,SUN Jing,DING Hui
(Dept. of Gynecology, First Maternity and Infant Hospital, Tongji University, Shanghai 200040, China)
Abstract:
Objective To evaluate the efficacy of a modified laparoscopic sacrocolpopexy (LSC) in treatment severe pelvic organ prolapse. Methods Between June 2014 and August 2018, 52 patients with pelvic organ prolapse underwent LSC at the First Maternity and Infant Hospital, Tongji University. All operations were performed with the assistance of a new instrument (uterine cone), and a Y-type mesh was used to correct the prolapse. The operation time, blood loss and postoperative POP-Q were assessed. The subjective cure rate was evaluated by the Pelvic Floor Distress Inventory, Short Form 20 (PFDI-20), the Incontinence Quality of Life (I-QOL), and the Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Results The operations were successfully performed in all patients. No complications were observed during operations, such as pelvic organ injury and massive hemorrhage. Mean operation time was (148.3 ± 32.0)min, and mean blood loss was (61.3 ± 46.4)mL. After median 22.5 months (15~40 months) of following-up, the POP-Q scores Aa, Ba, C, Ap and Bp decreased (P<0.001). The subjective cure rate was 94.2%, and the objective cure rate was 96.2%. The urinary incontinence occurred in 3 patients (1.9%) and the mesh exposed outside occurred in 2 patients (3.8%). The score of PFDI-20 and PISQ-12 improved significantly after the operation (P<0.05). Conclusion Laparoscopic sacrocolpopexy had both high objective and subjective cure rate. The new instrument (uterine cone) offers a good experience for surgeons and may lead to a better outcome.
Key words:  pelvic organ prolapse  laparoscopic sacrocolpopexy  instrument assistance  laparoscope

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