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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 303 -306. doi: 10.3877/cma.j.issn.1674-392X.2023.03.014

论著

两种悬吊术联合经阴道子宫全切术及阴道前壁修补术治疗重度子宫脱垂对比
郭垒†(), 刘敏   
  1. 235100　安徽淮北，濉溪县中医医院妇产科
  • 收稿日期:2022-11-15 出版日期:2023-06-18
  • 通信作者: 郭垒
  • 基金资助:
    2020年安徽省妇幼健康科研项目(2020FY14)

Comparison of the therapeutic efficacy of two combined suspension procedures with transvaginal total hysterectomy and anterior vaginal wall repair for severe uterine prolapse

Lei Guo†(), Min Liu   

  1. Department of Obstetrics and Gynecology of Suixi County Hospital of Traditional Chinese Medicine, Huaibei 235100, Anhui Province, China
  • Received:2022-11-15 Published:2023-06-18
  • Corresponding author: Lei Guo
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郭垒, 刘敏. 两种悬吊术联合经阴道子宫全切术及阴道前壁修补术治疗重度子宫脱垂对比[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 303-306.

Lei Guo, Min Liu. Comparison of the therapeutic efficacy of two combined suspension procedures with transvaginal total hysterectomy and anterior vaginal wall repair for severe uterine prolapse[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(03): 303-306.

目的

比较在经阴道子宫全切术（TVTH）基础上阴道前壁修补术联合阴道残端骨盆漏斗韧带悬吊术与腹腔镜下阴道前壁修补术加阴道残端腹壁悬吊术治疗重度子宫脱垂的临床疗效。

方法

选取2019年1月至2021年1月在濉溪县中医医院治疗的60例重度子宫脱垂患者，按照治疗悬吊方式的不同分为试验组（腔镜下阴道残端腹壁悬吊术，26例）和对照组（阴道残端骨盆漏斗韧带悬吊术，34例）。比较2组患者的临床疗效、围手术期指标，术后不同时间点的阴道残端水平、并发症情况及生活质量。

结果

试验组治疗有效率显著高于对照组（P<0.05）；试验组术中出血量少于对照组，手术时间长于对照组，住院时长、下床活动时间短于对照组，差异均有统计学意义（P<0.05）；试验组患者术后不同时间阴道残端水平均高于对照组（P<0.05），术后总并发症发生率低于对照组，术后各项生活质量评分优于对照组，差异均有统计学意义（P<0.05）。

结论

对于重度子宫脱垂患者，在TVTH基础上联合腹腔镜下阴道前壁修补术及阴道残端腹壁悬吊，并视脱垂情况酌情处理阴道后壁的术式有利于增强患者临床疗效、提高阴道残端水平，同时能减少术中出血量，促进患者早日下床活动，缩短住院时长，对减少术后并发症，提升患者生活质量具有重要意义。

关键词: 子宫脱垂, 经阴道子宫全切术, 阴道前壁修补术, 阴道残端骨盆漏斗韧带悬吊术, 阴道残端腹壁悬吊术, 疗效
Objective

Comparison of the therapeutic efficacy of two combined suspension procedures with transvaginal total hysterectomy and anterior vaginal wall repair for severe uterine prolapse.

Methods

A total of 60 patients with acute metroptosis who were treated in the Suixi County Hospital of Traditional Chinese Medicine from January 2019 to January 2021 were selected as research subjects. According to the different treatment methods, they were divided into an experimental group (laparoscopic vaginal stump abdominal wall suspension, 26 cases) and a control group (vaginal stump pelvic funnel ligament suspension, 34 cases). The clinical efficacy, perioperative indicators, postoperative vaginal stump level at different time, complications, and quality of life were compared between the two groups.

Results

The effective treatment rate in the experimental group was significantly higher than that in the control group (P<0.05). The amount of intraoperative bleeding in the experimental group was less than that in the control group, the operation time was longer than those in the control group, and the length of hospital stay and time to out-of-bed activity were shorter than that in the control group, the differences were all statistically significant (P<0.05). The postoperative vaginal stump level at different time points in the experimental group was higher than that in the control group (P<0.05), and the total postoperative complication rate was lower than that in the control group, and the postoperative quality of life scores were better than those in the control group, the differences were all statistically significant (P<0.05).

Conclusion

For patients with severe uterine prolapse, combined laparoscopic anterior vaginal wall repair and vaginal stump abdominal wall suspension based on vaginal hysterectomy, and considering appropriate treatment of the posterior vaginal wall according to the degree of prolapse, can enhance clinical efficacy and improve the level of the vaginal stump, while reducing intraoperative blood loss, promoting early out-of-bed activity, shortening hospital stays, reducing postoperative complications, and improving the quality of life of patients.

Key words: Uterine prolapse, Transvaginal total hysterectomy, Anterior colporrhaphy, Vaginal stump pelvic infundibular ligament suspension, Vaginal stump abdominal wall suspension, Efficacy
表1 2组患者治疗有效率比较[例（%）]
组别 例数 痊愈 显效 有效 无效 总有效率
试验组 26 5(19.23) 11(42.31) 9(34.62) 1(3.85) 25(96.15)
对照组 34 3(8.82) 10(29.41) 13(38.24) 8(23.53) 26(76.47)
χ2           4.477
P           0.034
表2 2组患者围手术期相关指标比较（±s）
组别 例数 手术时间(min) 下床活动时间(d) 住院时长(d) 术中出血量(ml)
试验组 26 99.87±9.51 2.83±0.66 5.09±1.27 45.34±6.69
对照组 34 92.53±9.25 3.32±0.74 5.86±1.48 51.07±7.24
t   2.998 2.662 2.121 3.138
P   0.004 0.010 0.038 0.003
表3 2组患者术后阴道残端水平比较（分，±s）
组别 例数 术后24 h 术后1个月 术后3个月 术后6个月
试验组 26 5.91±0.53# 5.66±0.50# 5.59±0.48# 5.18±0.45#
对照组 34 5.25±0.49 5.04±0.46 4.82±0.44 4.47±0.41
F   F组间=5.968，F时间=4.239，F交互=5.136
P   P组间=0.003，P时间=0.001，P交互=0.032
表4 2组患者术后并发症发生率比较[例（%）]
组别 例数 尿潴留 创口出血 创口感染 膀胱损伤 肠梗阻 总并发症
试验组 26 1(3.85) 1(3.85) 0 1(3.85) 0 3(11.54)
对照组 34 3(8.82) 2(5.82) 4(11.76) 2(5.82) 1(2.94) 12(35.29)
P             <0.0001
表5 2组患者术后生活质量评分（分，±s）
组别 例数 术前 术后3个月 术后6个月
试验组 26 28.96±5.74# 38.58±6.12# 46.36±6.69#
对照组 34 29.17±5.66 33.29±5.82 39.94±6.04
F   F组间=4.102，F时间=4.258，F交互=5.102
P   P组间=0.029，P时间=0.036，P交互=0.001
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