Abstract:

Objective　To analyze the clinical effects of three surgical methods in the treatment of patients with moderate to severe pelvic organ prolapse (POP). Methods　One hundred and twenty patients with moderate to severe POP who were treated in Zhengzhou Maternal and Child Health Hospital from October 2020 to October 2022 were selected for the randomized controlled trial. They were divided into group A, group B, and group C by the random number table method, with 40 cases in each group. Group A were (57.16±3.59) years old; there were 24 moderate cases and 16 severe cases in POP staging. Group B were (56.94±3.51) years old; there were 22 moderate cases and 18 severe cases in POP staging. Group C were (56.08±3.54) years old; there were 19 moderate cases and 21 severe cases in POP staging. Group A took vaginal total hysterectomy and anterior-posterior vaginal wall repair; group B took laparoscopic total hysterectomy and high-sacral ligament suspension surgery; group C took laparoscopic total hysterectomy and iliopubic ligament suspension surgery. The perioperative indicators, quality of life, sexual life quality, recurrence rates, and complications were compared between the three groups. χ² test, one-way analysis of variance, and LSD-t test were used. Results　The surgical times of group B [(125.74±31.52) min] and group C [(134.97±38.21) min] were longer than that of group A [(77.45±25.06) minutes]; the intraoperative bleeding volumes of group B [(57.12±21.09) ml] and group C [(55.74±19.53) ml] were lower than that of group A [(90.76±28.91) ml]; the hospitalization times of group B [(5.29±1.46) d] and group C [(5.34±1.29) d] were shorter than that of group A [(6.85±1.53) d]; the hospitalization costs of group B [(23 523.07±5 171.05) yuan] and group C [(24 135.65±5 208.47) yuan] were higher than that of group A [(15 241.35±4 472.18) yuan]; there were statistical differences (all P<0.05). After the surgery, the scores of the pelvic floor dysfunction questionnaire (PFDI-20) in the three groups were lower than those before the surgery, and the scores of the sexual life quality questionnaire (PISQ-12) were higher than those before the surgery; the scores of PFDI-20 in group B [(8.34±2.05)] and group C (8.19±2.41)] were lower than that in the group A [(10.56±2.17); the scores of PISQ-12 in group B [(41.15±2.97)] and group C [(40.87±2.64)] were higher than that in group A [(36.21±3.82)]; there were statistical differences (all P<0.05). The recurrence rate and total incidence of complications in group B and group C were lower than those group A, with statistical differences (all P<0.05). There were no statistical differences between group B and group C in terms of surgical time, intraoperative bleeding volume, time of exhaust, hospitalization time, hospitalization cost, postoperative scores of PFDI-20 and PISQ-12, recurrence rate, and total incidence of complications (all P>0.05). Conclusions　Laparoscopic total hysterectomy combined with high-sacral ligament suspension surgery and with iliopubic ligament suspension surgery for patients with moderate to severe POP both have the advantages of less trauma, fewer complications, faster postoperative recovery, and so on, and can improve their quality of life and sexual life quality. However, these two surgical methods are time-consuming and have relatively high hospitalization cost.

Key words:

Moderate to severe pelvic organ prolapse, Total hysterectomy, Repair of anterior and posterior vaginal walls, High-sacral ligament suspension surgery, Iliopubic ligament suspension surgery, Sexual life quality, Recurrence rate

摘要：

目的　分析3种不同术式治疗中重度盆腔器官脱垂（POP）患者的临床效果。方法　选取2020年10月至2022年10月于郑州市妇幼保健院治疗的120例中重度POP患者进行随机对照试验，采用随机数字表法将其分为A组、B组与C组，各40例。A组年龄（57.16±3.59）岁；POP分期：中度24例，重度16例。B组年龄（56.94±3.51）岁；POP分期：中度22例，重度18例。C组年龄（56.08±3.54）岁；POP分期：中度19例，重度21例。A组采用经阴道全子宫切除术+阴道前后壁修补术治疗；B组采用腹腔镜下全子宫切除术+高位骶韧带悬吊术治疗；C组采用腹腔镜下全子宫切除术+髂耻韧带悬吊术治疗。比较3组围手术期指标、生活质量、性生活质量、复发率及并发症。采用χ²检验、单因素方差分析及LSD-t检验。结果　B组、C组手术时间［（125.74±31.52）min、（134.97±38.21）min］均长于A组［（77.45±25.06）min］，术中出血量［（57.12±21.09）ml、（55.74±19.53）ml］均少于A组［（90.76±28.91）ml］，住院时间［（5.29±1.46）d、（5.34±1.29）d］均短于A组［（6.85±1.53）d］，住院费用［（23 523.07±5 171.05）元、（24 135.65±5 208.47）元］均高于A组［（15 241.35±4 472.18）元］，差异均有统计学意义（均P<0.05）。术后，3组盆底功能障碍问卷量表（PFDI-20）评分均低于术前，性生活质量问卷（PISQ-12）评分均高于术前，且B组、C组PFDI-20评分［（8.34±2.05）分、（8.19±2.41）分］均低于A组［（10.56±2.17）分］，PISQ-12评分［（41.15±2.97）分、（40.87±2.64）分］均高于A组［（36.21±3.82）分］，差异均有统计学意义（均P<0.05）。B组、C组复发率及并发症总发生率均低于A组，差异均有统计学意义（均P<0.05）。B组与C组手术时间、术中出血量、排气时间、住院时间、住院费用、术后PFDI-20评分及PISQ-12评分、复发率及并发症总发生率比较，差异均无统计学意义（均P>0.05）。结论　中重度POP患者采用腹腔镜下全子宫切除术+高位骶韧带悬吊术与腹腔镜下全子宫切除术+髂耻韧带悬吊术治疗均具有创伤小、并发症少及术后恢复快等优点，能够提高患者的生活质量及性生活质量，但这两种术式手术耗时长且住院费用相对较高。

关键词:

中重度盆腔器官脱垂, 全子宫切除术, 阴道前后壁修补术, 高位骶韧带悬吊术, 髂耻韧带悬吊术, 性生活质量, 复发率