【作者】 杨慧；

【导师】 韩璐；

【作者基本信息】 大连医科大学 ， 妇产科学， 2012， 硕士

【摘要】 目的：探讨盆底重建手术中保留子宫和切除子宫的近中期临床疗效。方法：选择2007年9月至2011年9月大连市妇产医院63例存在不同缺陷的女性盆腔器官脱垂患者，按盆腔器官脱垂POP-Q分期均为Ⅲ-Ⅳ期，除外阴道穹窿脱垂患者。根据年龄、病情、有无合并症及患者意愿选择合理手术方式，分别施行添加补片进行保留子宫（UC组）和切除子宫（CH组）的盆底重建手术。比较两组患者的手术相关情况，术后POP-Q分期和PFDI-20（pelvic floor distressinventory-short form20）盆底功能障碍问卷作为主客观指标，评价术后近中期主观及客观治愈率。结果：（1）两组患者一般资料差异无统计学意义（P＞0.05）。（2）两组患者手术时间、出血量、术后住院时间比较，差异有统计学意义（P＜0.05），UC组平均手术时间80.73±29.68min，明显短于CH组114.03±26.59min；UC组术中平均出血量103.94±67.87ml,显著少于CH组165.33±71.62ml；UC组术后住院平均时间7.42±2.18天，少于CH组8.87±2.22天。保留尿管时间两组比较差异无统计学意义（P＞0.05），UC组保留尿管平均时间5.42±2.14天，CH组保留尿管平均时间6.30±2.04天。（3）UC组和CH组术前Aa、Ba、C、D、Ap、Bp、gh、pb、tvl各点POP-Q数值无统计学差异(P＞0.05)。两组术后各点数值比较，除tvl外，其余各点差异无统计学意义(P＞0.05)，CH组术后阴道长度较UC组缩短,差异有统计学意义(P＜0.05)。两组术前术后POP-Q各点数值相比,除UC组tvl外，其余各点差异均有统计学意义(P＜0.05)，UC组术前术后tvl差异无统计学意义(P＞0.05)。两组术前PDFI-20评分比较差异无统计学意义（P＞0.05）；术后6个月、12个月PDFI-20评分评分与术前比较差异均有统计学意义（P＜0.05）。术后各组评分差异无统计学意义（P＞0.05），两种手术方式对改善盆腔脏器脱垂效果相似。随访6-51月（平均27个月），至随访结束，UC组33例主观治愈率为93.94%，客观治愈率90.91%，3例复发，复发率为9.09%。CH组30例主观治愈率83.33%,客观治愈率80%，6例复发，复发率为20%。两组各有1例发生网片外露，两组术后均无感染、补片侵蚀发生。结论：1保留子宫的盆底重建术手术时间短,术中出血少，术后恢复快，有利于降低中老年女性患者的围手术期风险。2保留子宫和切除子宫的盆底重建术均是治疗POP的有效方法，近中期临床主客观治愈率相似。3保留子宫的盆底重建术对维持整个骨盆底结构的稳定性有重要意义，近中期临床疗效明确,远期临床效果、并发症及对患者生活质量的影响仍需进一步长期随访观察。更多还原

【Abstract】 Objective: To investigate the short-term clinical efficacy of uterus conservationand hysterectomy in pelvic reconstructive surgery.Method:From September2007to September2011,there are63patients in DalianObstetrics and Gynecology Hospital of different defects in women with pelvic organprolapse. According to pelvic organ prolapse POP-Q stage and with the exception ofvaginal vault prolapse, they were III—IV period. According to age, disease severity,with or without complication and the willingness of patients to choose a reasonableoperation mode, respectively apply add mesh with preservation of the uterus (group UC)and hysterectomy (group CH) of the pelvic floor reconstruction operation. Compare thepostoperative treatment efficacy of two groups of patients. During operation periodindex, preoperative POP-Q staging and PFDI-20(pelvic floor distress inventory-shortform20) as the main objective to evaluate the postoperative short-term cure rate ofsubjective and objective.Results:(1)No significant differences emerged in demographic and clinicalcharacteristics between the UC group and CH group (P>0.05).(2)Operating time,operative hemorrhage, in-hospital time post-operation of the two group had significantdifference (P <0.05). Mean operating time of UC group(80.73±29.68minutes) wassignificantly less than CH group (114.03±26.59minutes); mean operative hemorrhageloss was obviously less in UC group (103.94±67.87ml) than in CH group(165.33±71.62ml); mean in-hospital time post-operation was significantly less in UCgroup (7.42±2.18days) vs (8.87±2.22days) in CH group. Retain urine tube days of thetwo group had no significant difference (P>0.05), UC group retain urine tube (5.42±2.14days), CH group retain urine tube (6.30±2.04days).(3)No significantdifferences existed in POP-Q scores of Aa, Ba, C, Ap, Bp, D, gh, pb and tvl betweenCH and UC group preoperative (P>0.05). Various points values in the two groups aftersurgery compared，in addition to tvl，the remaining points was not statisticallysignificant (P>0.05). The CH group vaginal length was shorter after operation than theUC group,the difference was statistically significant (P <0.05).Two groups beforesurgery and after surgery, the POP-Q for each point value compared,in addition to UCgroup of tvl,the differences were statistically significant (P<0.05),but there were nostatistical significance on tvl in group UC(P>0.05).No significant differences existed inpreoperative PFDI-20score between CH group and UC group preoperative (P>0.05),compared with the preoperative, scores of PFDI-20in the two groups after the operation6months and12months were significant differences (P<0.05). While no significantdifferences presented among scores at different postoperative time (P>0.05),whichshows that the two groups had similar result. The mean follow-up time was27months(6-51months). To the end of the follow-up to, subjective cure rate of UC group was93.94%, and objective cure rate90.91%,3cases relapse, the recurrence rate was9.09%,subjective cure rate of CH group was83.33%, and objective cure rate80%,6cases relapse, the recurrence rate was20%. Two groups of each have one case of meshexposed, two groups were no postoperative infection and mesh erosion occurred.Conclusion:1Uterus conservation group has shorter operating times, lessoperative hemorrhage and postoperative rehabilitation faster, that is useful for reducingthe perioperative risks middle-aged and old women.2The pelvic reconstructivesurgery which uterus conservation and hysterectomy is an effective method of treatmentof POP, short-time clinical cure rate is similar between the subjective and objective.3The pelvic reconstructive surgery with uterus conservation is meaningful to maintainpelvic stable structure. It has a definite short-term effect, while its long-term effect、complications and impact on patients’ quality of life needs further long-term follow-upobservation.更多还原