腹腔镜下腹膜外子宫悬吊术疗效评估和生活质量评价

摘要

目的 评价腹腔镜腹膜外子宫悬吊手术对盆腔脏器脱垂患者症状和生活质量的影响.方法 2008年6 ～2011年2月行腹腔镜下腹膜外子宫悬吊手术30例,回顾性分析临床资料,并对25例进行定期随访,随访包括妇科检查及问卷调查两部分.术前及术后填写生活质量调查问卷(PFDI-20短表、PFIQ-7简要版和性功能问卷表)进行生活质量评价和POP-Q评估手术效果.结果 25例平均随访(13.12±5.54)个月,2例随访4个月后失访.客观治愈率100％,无复发病例,无手术并发症,25例患者C点和D点值术前与术后差异有显著性(P ＜0.001),PFDI-20和PFIQ-7平均术后得分均较术前显著降低,差异有显著性(P ＜0.001),而CRADI-8和CRAIQ-7术前术后得分差异无显著性(P＞0.001).PISQ-12评分术前术后差异有显著性(P ＜0.001).结论 腹腔镜腹膜外子宫悬吊术不仅能够有效地恢复患者的解剖学结构,而且对于患者的主观脱垂症状及生活质量都有显著的改善.%[ Objective ] To evaluate the effect of laparoscopie extraperitoneal uterine suspension to anterior abdominal wall bilaterally on patients' clinical symptoms and quality of life (QOL). [Methods] 30 patients with vaginal and uterine prolapse underwent laparoscopie extraperitoneal uterine suspension from June 2008 to February 2011, 25 patients were admitted to this study. Clinical data were retrospectively analyzed and regular follow-up was taken. Anatomical outcome as measured by the pelvic organ prolapse quantification (POP-Q) score was obtained from their pelvic examination. Functional evaluation was assessed by the following questionnaires: pelvic floor distress inventory-short form 20 (PFDI-20), pelvic floor distress impact questionnaire-short form 7 (PFIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). [Results] All patients were followed up, with a mean of follow up months of (13.12+5.54) months, after four months, two patents lost follow-up, The objective cure rates at 3 months was 100%. There were no major intraoperative or postoperative complications, and no recurrence. The POP—Q scores for points C and D were significantly further away from the hymen after operation than compared with the preoperative values (P <0.001). The PFDI-20 and PFIQ—7 scores at 3 and 6 months after surgery improved rn significantly compared with the baseline scores (P <0.001), The colorectal subscale of the PFDI-20 and PFIQ-7 demonstrated no significant change in scores at 3 and 6 months after surgery (P >0.001), baseline PISQ-12 score changed significantly compared with the value at 3 months after operation (P <0.001). [Conclusions] Laparoscopic extraperitoneal uterine suspension to anterior abdominal wall bilaterally can not only effectively recover patients' anatomical structure, but also can significantly improve patients' quality of life and subjective prolapse symptoms.