腹腔鏡環宮頸子宮骶骨固定術療效評估和生活質量評價

曹變娜　郭久柏　吳斐　羅美

【摘要】 目的：探討并評價腹腔鏡環宮頸子宮骶骨固定手術（LCSH）對中盆腔臟器脫垂患者癥狀和生活質量的影響，評估該手術的有效性和安全性。方法：回顧性分析2016年12月-2018年3月在本院因重度中盆腔臟器脫垂行LCSH的患者30例的臨床資料。觀察圍術期情況，比較手術前后盆腔器官脫垂定量分期法（POP-Q）各指示點位置、生活質量（PFDI-20），觀察解剖治愈、失敗及復發情況。

結果：30例患者均順利完成手術，平均手術時間（101.90±25.35）min;平均術中出血量50（30）mL;平均留置尿管時間（1.77±0.42）d;患者術后恢復良好，平均術后住院時間（3.97±0.75）d;平均隨訪（7.65±2.61）個月;無術中及術后嚴重并發癥;解剖學治愈率100%，無復發、失敗病例;患者手術前后各指示點位置比較，差異均有統計學意義（P<0.001）;患者術后末次隨訪時的PFDI-20、POPDI-6、UDI-6評分均低于術前（P<0.001）;手術前后CRADI-8評分比較，差異無統計學意義（P>0.05）。

結論：LCSH適用于要求保留子宮的中盆腔器官脫垂患者，尤其是年輕女性，網片放置位置更低，手術難度降低、手術時間縮短，解剖學治愈率高，不僅能較好達到解剖學復位，還能達到較好的功能學復位，顯著改善患者的生活質量，患者及配偶術后性生活滿意度較高。

【關鍵詞】 中盆腔器官脫垂; 子宮脫垂; 腹腔鏡環宮頸子宮骶骨固定術

【Abstract】 Objective：To evaluate the effect of laparoscopic cerclage sacrohysteropexy for mid-pelvic organ prolapsed patients clinical symptoms and quality of life（QOL），to assess the effectiveness and safety.

Method：The clinical data of 30 patients with severe mid-pelvic organ prolapsed undergoing LCSH from December 2016 to March 2018 were retrospectively analyzed.The perioperative period was observed，the location of POP-Q and quality of life（PFDI-20）were compared before and after operation，anatomical cure，failure and recurrence were observed.Result：The average operation time was（101.90±25.35）min，the average intraoperative bleeding volume was

50（30）mL，the average indwelling catheter time was（1.77±0.42）d，the patients recovered well after operation with an average hospitalization time of（3.97±0.75）d，the average follow-up time was（7.65±2.61）months，there were no serious complications during and after operation，the anatomical cure rate was 100%，no recurrence or failure cases.The position of indicating points before and after operation were compared，the differences were statistically significant（P<0.001）.The PFDI-20，POPDI-6 and UDI-6 scores at the last follow-up after operation were lower than those of before operation（P<0.001），but the CRADI-8 score before and after operation was compared，the difference was not statistically significant（P>0.05）.Conclusion：LCSH suitable for mid-pelvic organ prolapsed patients who require the retention of the uterus，especially young women，the placement of the mesh is lower，the difficulty of operation is reduced，the time of operation is shortened，and the cure rate of anatomy is high，it can not only achieve better anatomical reduction，but also achieve better functional reduction，it can significantly improve the quality of life of patients，the satisfaction of sexual life of patients and spouses after operation is higher.