以改良腹腔镜髂耻韧带悬吊术为核心的全盆底重建术在盆腔器官脱垂中的应用

doi:10.3877/cma.j.issn.1674-392X.2026.02.002

目的

探讨以改良腹腔镜髂耻韧带悬吊术（MLP）为核心的全盆底重建术（命名为"朝阳陈氏全盆底重建术"，简称陈氏手术）治疗盆腔器官脱垂（POP）的疗效与安全性。

方法

本研究为单中心回顾性队列研究。回顾性分析2020年3月至2024年12月于北京朝阳医院接受陈氏手术的189例病例的临床资料。手术使用"朝阳网片"将髂耻韧带悬吊与骶韧带悬吊、圆韧带缩短、阴道前后壁修补等结合。比较手术前后盆腔器官脱垂定量分期（POP-Q）各指示点、盆底功能障碍量表（PFDI-20）和盆底功能影响问卷（PFIQ-7）评分变化。

结果

手术后，POP-Q各指示点Aa、Ba、Ap、Bp、C、D较术前均显著提升，全部修复至处女膜水平以上，所有患者均达到满意的解剖及功能修复。Aa、Ba、C、Ap、Bp、D手术前后测量差值分别为[M（P₂₅，P₇₅）]3.50（2.00，5.00）、5.00（2.50，6.00）、8.00（6.00，10.00）、2.00（1.50，3.50）、3.50（2.00，5.00）、7.00（5.50，9.50），差异均有统计学意义（Z=－11.57、－11.74、－11.92、－11.68、－11.81、－11.54，P均<0.001）。术后PFDI-20及PFIQ-7评分均较术前显著降低，差值分别为128.13（87.50，168.75）分、152.38（104.76，188.10）分，差异均有统计学意义（Z=－11.92、－11.92，P均<0.001）。围手术期无严重并发症，术后新发压力性尿失禁和排尿歪斜1例、下肢深静脉血栓形成8例。随访12~60个月，随访期内无复发。

结论

以陈氏手术治疗POP短中期疗效可靠，安全性良好。

关键词: 盆腔器官脱垂, 改良髂耻韧带悬吊术, 全盆底重建

Objective

To evaluate the efficacy and safety of total pelvic floor reconstruction centered on modified laparoscopic pectopexy (MLP), designated as "Chaoyang-Chen Total Pelvic Floor Reconstruction" (Chen's procedure for short), in the treatment of pelvic organ prolapse (POP).

Methods

This was a single-center retrospective cohort study. A retrospective analysis was performed on 189 patients who underwent Chen's procedure at Beijing Chaoyang Hospital between March 2020 and December 2024. The procedure utilized the self-designed "Chaoyang mesh" and combined pectopexy with uterosacral ligament suspension, round ligament shortening, and anterior and posterior vaginal wall repair. Anatomical outcomes were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system before and after the surgery. Symptom severity and quality of life were evaluated using the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7).

Results

After the surgery, all POP-Q measurement points (Aa, Ba, Ap, Bp, C, and D) were significantly elevated compared with preoperative values, and all were restored to above the hymenal level. Satisfactory anatomical and functional repair was achieved in all patients. The preoperative-to-postoperative differences in Aa, Ba, C, Ap, Bp, and D were 3.50 (2.00, 5.00), 5.00 (2.50, 6.00), 8.00 (6.00, 10.00), 2.00 (1.50, 3.50), 3.50 (2.00, 5.00), and 7.00 (5.50, 9.50), respectively, with statistically significant differences (Z=-11.57, -11.74, -11.92, -11.68, -11.81, -11.54; all P<0.001). Postoperative PFDI-20 and PFIQ-7 scores were significantly lower than preoperative scores, with differences of 128.13 (87.50, 168.75) and 152.38 (104.76, 188.10), respectively. The differences were statistically significant (Z=-11.92, -11.92; both P<0.001). No severe perioperative complications occurred. New-onset stress urinary incontinence occurred in 1 patient, abnormal urination in 1 patient, and deep vein thrombosis of lower extremities in 8 patients. Follow-up ranged from 12 to 60 months. No recurrence was observed during follow-up period.

Conclusion

Chen's procedure provides reliable short- and mid-term efficacy with favorable safety in patients with POP.

Key words: Pelvic organ prolapse, Modified laparoscopic pectopexy, Total pelvic floor reconstruction

图6 缝合关闭盆腔腹膜包埋朝阳网片同时折叠缝合圆韧带

表1 盆腔器官脱垂患者术前脱垂部位及分期（n=189）

脱垂部位	POP-Q	例(%)
阴道前壁脱垂	Ⅰ	7(3.7)
	Ⅱ	45(23.8)
	Ⅲ	84(44.4)
	Ⅳ	53(28.0)
顶端脱垂子宫(穹隆)脱垂	Ⅰ	0(0.0)
	Ⅱ	66(34.9)
	Ⅲ	72(38.1)
	Ⅳ	51(27.0)
阴道后壁脱垂	Ⅰ	5(2.6)
	Ⅱ	88(46.6)
	Ⅲ	70(37.0)
	Ⅳ	26(13.8)

表1 盆腔器官脱垂患者术前脱垂部位及分期（n=189）

脱垂部位	POP-Q	例(%)
阴道前壁脱垂	Ⅰ	7(3.7)
	Ⅱ	45(23.8)
	Ⅲ	84(44.4)
	Ⅳ	53(28.0)
顶端脱垂子宫(穹隆)脱垂	Ⅰ	0(0.0)
	Ⅱ	66(34.9)
	Ⅲ	72(38.1)
	Ⅳ	51(27.0)
阴道后壁脱垂	Ⅰ	5(2.6)
	Ⅱ	88(46.6)
	Ⅲ	70(37.0)
	Ⅳ	26(13.8)

图8 189例盆腔器官脱垂患者行陈氏手术前后盆底功能及生活质量评分比较箱线图

表2 189例盆腔器官脱垂患者行陈氏手术前后POP-Q指示点位置、PFDI-20和PFIQ-7评分比较[M（P₂₅，P₇₅）]

观察项目	术前	术后3个月	差值	Z值	P值
POP-Q
Aa	2.00(0.00,3.00)	-2.00(-2.50,-1.50)	3.50(2.00,5.00)	-11.57	<0.001
Ba	3.00(1.00,4.00)	-2.00(-2.50,-1.50)	5.00(2.50,6.00)	-11.74	<0.001
C	2.00(0.00,4.00)	-5.50(-6.00,-5.00)	8.00(6.00,10.00)	-11.92	<0.001
Ap	0.00(-1.00,1.00)	-2.50(-3.00,-2.00)	2.00(1.50,3.50)	-11.68	<0.001
Bp	1.00(0.00,3.00)	-2.50(-3.00,-2.00)	3.50(2.00,5.00)	-11.81	<0.001
D	1.00(-1.00,3.00)	-6.50(-7.00,-6.50)	7.00(5.50,9.50)	-11.54	<0.001
PFDI-20	136.46(96.88,183.86)	12.50(4.17,18.23)	128.13(87.50,168.75)	-11.92	<0.001
PFIQ-7	157.14(116.67,214.29)	14.29(4.76,21.43)	152.38(104.76,188.10)	-11.92	<0.001

表2 189例盆腔器官脱垂患者行陈氏手术前后POP-Q指示点位置、PFDI-20和PFIQ-7评分比较[M（P₂₅，P₇₅）]

观察项目	术前	术后3个月	差值	Z值	P值
POP-Q
Aa	2.00(0.00,3.00)	-2.00(-2.50,-1.50)	3.50(2.00,5.00)	-11.57	<0.001
Ba	3.00(1.00,4.00)	-2.00(-2.50,-1.50)	5.00(2.50,6.00)	-11.74	<0.001
C	2.00(0.00,4.00)	-5.50(-6.00,-5.00)	8.00(6.00,10.00)	-11.92	<0.001
Ap	0.00(-1.00,1.00)	-2.50(-3.00,-2.00)	2.00(1.50,3.50)	-11.68	<0.001
Bp	1.00(0.00,3.00)	-2.50(-3.00,-2.00)	3.50(2.00,5.00)	-11.81	<0.001
D	1.00(-1.00,3.00)	-6.50(-7.00,-6.50)	7.00(5.50,9.50)	-11.54	<0.001
PFDI-20	136.46(96.88,183.86)	12.50(4.17,18.23)	128.13(87.50,168.75)	-11.92	<0.001
PFIQ-7	157.14(116.67,214.29)	14.29(4.76,21.43)	152.38(104.76,188.10)	-11.92	<0.001

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[15]	符小航, 张慧叶, 李昂, 许欢, 李杰, 杨鉴冰. "妇三针"治疗产后盆腔器官脱垂的理论探析[J/OL]. 中华针灸电子杂志, 2024, 13(02): 85-88.

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Application of total pelvic floor reconstruction with modified laparoscopic pectopexy as the core in pelvic organ prolapse

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Application of total pelvic floor reconstruction with modified laparoscopic pectopexy as the core in pelvic organ prolapse