腹腔镜下高位骶韧带悬吊术治疗中盆腔缺陷14例分析

摘要

目的：探讨腹腔镜下高位宫骶韧带悬吊术治疗子宫脱垂的有效性和安全性。方法2011年10月至2013年7月于锦州市妇婴医院妇科因 POP-Q 分期 II-III 期子宫脱垂行腹腔镜下高位骶韧带悬吊术治疗的患者14例，以主观症状和 POP-Q 测量评价患者的主观、客观治愈率、复发率；评价手术前后患者的生活及性生活质量。结果患者平均手术时间（110±41）min，平均失血量（70±19）mL，无术中并发症。术后平均住院时间（3.8±1.1）d。平均随访10.21m，患者主观及客观治愈率均100％。14例患者术前、术后 C 点分别为（+2.1±0.9） cm 和（-6.6±0.5）cm，D 点分别（-3.9±0.8）cm 和（-6.8±0.6）cm，差异有统计学意义（P<0.05）。l4例患者中10例有规律性生活接受性生活质量调查，均较术前明显改善。结论腹腔镜下高位骶韧带悬吊术是治疗以子宫脱垂为主的中盆腔缺陷的安全有效的手术方法，可明显改善患者术后生活及性生活质量。%Objective To assess the surgical outcome of laparoscopic high uterosacral uterine suspension(LHUS)for the treatment of uterine prolapse. Methods This14 women with uterine prolapsed stage II-III underwent laparoscpic high uterosacral ligament suspension from October 2011 to July 2013 in the Women and Children Hospital of Jinzhou.Pre and postoperative symptoms, pelvic organ prolapse quantitation(POP-Q)stage were used to assess anatomic outcome, subjective and objective cure rate,quality of life and sexual life outcome. Results All procedures were successfully completed laparoscopically.The patients’ mean operating time was (110±41)min(range 90~140min), and the mean blood was(70±19)mL range 40~150m1).The postoperative stay was(3.8±1.1) days (range3~5d).After a mean follow-up of 10.21 months (range 3~24months), 14 women had no symptoms of uterine prolapse.The POP-Q scores for points C and D were significantly further away from the hymen after operation than compared with the preoperative values [C:(+2.1±0.9)cm vs(-6.6±0.5)cm.D:(-3.9 ±0.8)cm vs(-6.8±0.6)cm,P<0.05]. There was significant improvewent between preoperative and postoperative scores of sex life quality questionnaire on ten patients of fourteen ones who had regular sex.Conclusions The laparoscpic high uterosacral ligament suspension is efecitve and safe in the management of symptomatic uterine prolapse. It may significantly improve the quality of life and sexual life.