经阴道坐骨棘筋膜固定缝合术与骶棘韧带固定缝合术治疗盆腔器官脱垂的临床效果评价

摘要

目的：探讨经阴道坐骨棘筋膜固定缝合术（ ischial spinous fascia fixation ，ISFF ）与骶棘韧带固定术（ sacrospinous ligament fixation，SSLF）治疗子宫脱垂的有效性和安全性。方法选取2010年3月至2016年1月在佛山市妇幼保健院治疗的子宫脱垂患者34例，采用双盲法随机分为两组，分别实施ISFF（18例）和SSLF（16例）两种术式，采用盆腔器官脱垂定量分期法评估两组手术治疗效果。结果 ISFF组和SSLF组术中出血量分别为（50±10.5）mL、（92±8.2）mL，手术时间分别为（60±8.6）min 、（74±9.6）min；术后住院时间分别为（4.2±0.8）d 、（4.5±1）d。术前ISFF组患者子宫C点（＋2.60±0.20）cm、D点（－3.91±0.61）cm；SSLF组C点（＋2.61±0.13）cm、D点（－3.89±1.20）cm。术后检查ISFF组患者C点（－5.69±0.51） cm、D点（－6.87±0.32）cm；SSLF组C点（－5.70±0.60）cm、D点（－7.00±0.30）cm；两组手术前后比较差异均有统计学意义（P＜0.05），但两组间治疗效果比较差异无统计学意义（P＞0.05）。术后随访24个月，最后有6例患者失访。术后3月随访28例患者有正常性生活，6例患者因自身原因拒绝性生活。结论 ISFF是利用自身组织治疗子宫脱垂，具有治愈率高、复发率低、费用低，安全微创、术后对性生活影响小等优点。%Objective To study the effectiveness and safety of ischial spinous fascia fixation ( ISFF ) and vaginal sacrospinous ligament fixation(SSLF) in treating patients with uterine prolapse.Methods 34 patients with uterine prolapse from March 2010 to January 2016 in Foshan Women and Children Healthcare Hospital were selected.They were randomly divided into two groups , ISFF (18 cases) and vaginal SSLF(16 cases)were carried out.Using pelvic organ prolapse quantitation to assess operational outcomes .Results The bleeding of ISFF group and SSLF group were (50 ±10.5)mL and(92 ±8.2)mL, the operation time were(60 ±8.6)min and (74 ±9.6)min.The time in hospital after operation were (4.2 ±0.81)d and (4.5 ±1)d.Before operation, the C point of ISFF group was at(+2.61 ±0.13)cm, D point at (-3.91 ±0.61)cm;the C point of SSLF group was at (+2.60 ±0.20)cm, D point at ( -3.89 ± 1.20)cm;After operation,the C point of ISFF group was at(-5.69 ±0.51)cm, D point at (-6.87 ±0.32)cm;the C point of SSLF group was at (-5.70 ±0.60 ) cm, D point at (-7.00 ±0.30 ) cm;preoperative and postoperative therapy effects of two groups was statistically significant ( P <0.05 ) , while the treatment effects of two groups were not significantly different ( P >0.05 ) .Post -operation follow-up for 24 months, 6 patients were lost to follow -up.28 patients had normal sexual life 3 months after operation ,6 patients refused sexual life for self -reasons.Conclusion Using autologous tissue,ISFF is safe and efficient operational way for the patients with uterine prolapse .It has advantage of higher cure rate ,minimally invasion ,low cost and smaller influence for sex .