经腹腔镜子宫/ 阴道骶骨固定术与改良式全盆底功能重建术对盆腔脏器脱垂的临床效果
| 作者: |
1周春艳,
1杨铧琦,
1卢白玉
1 遂宁市中心医院妇产科，四川 遂宁 629000 |
| 通讯: |
杨铧琦
Email: xechen352@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.05.012 |
| 基金: | 四川省卫生和计划生育委员会科研课题(16PJ527)。 |
摘要
目的：探讨经腹腔镜子宫/阴道骶骨固定术与改良式全盆底功能重建术对盆腔脏器脱垂患者临床效果的影响。方法：选择2016年1月至2018年3月在遂宁市中心医院接受治疗的盆腔脏器脱垂患者108例进行研究。采用随机数字表法将患者分为2组，对照组行改良式全盆底功能重建术共 54例，观察组行经腹腔镜子宫/阴道骶骨固定术，共54例。对比两组患者尿动力学参数、客观治愈率、主观满意率、生活质量及并发症发生情况。结果：对照组平均尿流率、最大尿流率及最大膀胱容量均明显升高(t对照=−2.142，−5.217，−1.679，P对照<0.05；t观察=−5.704，−7.748，−3.074， P观察<0.001)，但观察组升高幅度更大，两组残余尿量均明显下降，但观察组下降程度更明显。术后两组盆底肌肌电均明显下降(t对照=1.697，P对照=0.046；t观察=2.571，P观察=0.006)，观察组下降幅度更小。术后两组患者盆底生活质量及性生活质量水平均明显上升(t对照=−6.895，−7.765， P对照<0.001；t观察=−11.443，−10.421，P观察<0.001)，但观察组上升幅度更大。两组患者MDA及GSSG水平均明显下降(t对照=4.140，5.305，P对照<0.001；t观察=9.154，14.861，P观察<0.001)，但观察组下降更为明显(P<0.05)；两组SOD及GSH水平均明显上升(t对照=−5.150，−3.163，P对照<0.001； t观察=−7.897，−6.466，P观察<0.001)，但观察组上升幅度更大。结论：经腹腔镜子宫/阴道骶骨固定术与改良式全盆底功能重建术相比可明显改善盆腔脏器脱垂患者下尿路功能，降低盆底肌肌电，改善盆底生活质量及性生活质量，缓解氧化应激反应。
关键词：
经腹腔镜子宫/阴道骶骨固定术；改良式全盆底功能重建术；盆腔脏器脱垂；下尿路功能
Clinical effects of laparoscopic uterine/vaginal iliac bone fixation and modified total pelvic function reconstruction on pelvic organ prolapse
CorrespondingAuthor: YANG Huaqi Email: xechen352@163.com
DOI: 10.3978/j.issn.2095-6959.2019.05.012
Foundation: This work was supported by Scientific Research Project of Sichuan Health and Family Planning Commission, China (16PJ527).
Abstract
Objective: To investigate the clinical effects of laparoscopic uterine/vaginal sacral fixation and modified total pelvic floor reconstruction on pelvic organ prolapse. Methods: A total of 108 patients with pelvic organ prolapse treated in our hospital from January 2016 to March 2018 were enrolled. The patients were divided into two groups by random number table method. The control group underwent modified total pelvic floor function reconstruction in 54 cases. The observation group underwent laparoscopic uterine/vaginal iliac bone fixation in 54 cases. The urodynamic parameters, objective cure rate, subjective satisfaction rate, quality of life and complications were compared between the two groups. Results: The mean urinary flow rate, maximum urinary flow rate and maximum bladder volume of the control group were significantly increased (tcontrol=−2.142, −5.217, −1.679, Pcontrol<0.05; tobservation=−5.704, −7.748, −3.704, Pobservation<0.001), but the increase in the observation group was greater, and the residual urine volume of the two groups decreased significantly, but the degree of decline in the observation group was more obvious. The pelvic floor muscle myoelectricity of the two groups was significantly decreased after operation (tcontrol=1.697, Pcontrol=0.046; tobservation=2.571, Pobservation=0.006), but the observation group decreased more. The quality of life and quality of life of the pelvic floor in the two groups were significantly increased after operation (tcontrol=−6.895, −7.765, Pcontrol<0.001; tobservation=−11.443, −10.421, Pobservation<0.001) However, the observation group has increased even more. MDA and GSSG levels were significantly decreased in the two groups (tcontrol=4.140, 5.305, Pcontrol<0.001; tobservation=9.154, 14.861, Pobservation<0.001), but the observation group decreased more significantly (P<0.05), the SOD and GSH levels of the two groups were significantly increased (tcontrol=−5.10, −3.163, Pcontrol<0.001; tobservation=−7.897, −6.466, Pobservation<0.001), but the observation group The increase is even greater. Conclusion: Laparoscopic uterus/vaginal iliac bone fixation can significantly improve lower urinary tract function, reduce muscle myoelectricity and improve pelvic floor quality and sexual life in patients with pelvic organ prolapse compared with modified total pelvic floor reconstruction. Quality relieves oxidative stress.
Keywords：
laparoscopic uterus/vaginal sacral fixation; modified total pelvic floor reconstruction; pelvic organ prolapse; lower urinary tract function