阴道全封闭术治疗老年重度盆腔脏器脱垂20例临床分析

摘要

目的：探讨阴道全封闭术治疗老年重度盆腔脏器脱垂的手术效果和安全性。方法回顾性分析20例航天中心医院妇科2009年4月~2014年4月行阴道全封闭手术的重度盆腔脏器脱垂患者的资料，记录围术期参数及并发症，采用盆腔脏器脱垂症状困扰量表(PFDI-20短表)评价患者手术前后症状及生命质量改善情况，评价手术疗效。结果20例经盆腔器官脱垂定量(POP-Q)分度法分期为Ⅲ~Ⅳ期的患者均行经阴道全子宫切除加阴道全封闭术，其中有2例同时行经闭孔无张力尿道中段悬吊术，另有2例同时行会阴陈旧裂伤修补术。手术平均历时(68±22)min；平均出血(137±111)mL；术后恢复排尿中位天数4 d，发生尿路感染1例，新发压力性尿失禁3例，无一例患者死亡。术后平均随访12个月，患者主客观治愈率为100%，均对手术效果满意，无一例后悔。术后患者PFDI-20生命质量评分[(10.78±4.60)分]较术前[(88.42±7.60)分]显著下降，差异有高度统计学意义(P=0.000)。结论对于无性生活要求的重度盆腔脏器脱垂的老年患者，阴道全封闭术能显著改善其生命质量，手术满意度高，后悔率低，是治疗该类患者安全、有效的方法。%Objective To evaluate the efficacy and safety of total colpocleisis in treating elderly patients with severe pelvic organ prolapsed. Methods The clinical data of twenty patients with severe pelvic organ prolapse who underwent total colpocleisis from April 2009 to April 2014 in Department of Gynecology of Aerospace Center Hospital was retro-spectively analyzed. Perioperative parameters and complications were recorded, the symptoms and improvement condi-tions of quality of life were assessed by the questionnaire of the pelvic floor distress inventory-short form 20 (PFDI-20), the surgical effect was evaluated. Results Twenty patients staged pelvic organ prolapsed quantification (POP-Q) Ⅲ-Ⅳunderwent hysterectomy and total colpocleisis, of which two underwent tension-free vaginal tape obturator, two under-went perinea laceration repair at meanwhile. The mean operation time was (68±22) min, the mean intraoperative blood loss was (137±111) mL. The median days of restoring micturition after operation was 4 days. One patient had urinary tract infection, three patients had de novo urinary incontinence and no patients post-operative mortality occurred. Patients were followed up for 12 months on average, the subjective and objective cure rate were both 100%. 100%patients were satisfactory and no one regret. PFDI-20 scores at post-operation [(10.78±4.60) points] were decreased significantly compared to pre-operation [(88.42±7.60) points], the difference was highly statistically significant (P=0.000). Conclu-sion For elderly patients with severe pelvic organ prolapsed who had no requirement for sex, the total colpocleisis can remarkably improve the quality of life, the satisfaction with the operation was high, the regret ratio was low, which is a safe and effective method for these patients.