硅胶子宫托与手术治疗盆腔器官脱垂的疗效观察

摘要

Objective To explore the outcomes of silicone pessary versus surgery for symptomatic pelvic organ prolapse (POP) using Pelvic Floor Distress Inventory-Short Form (PFDI-20) and Pelvic Floor Impact Questionnaire Short Form (PFIQ-7).Methods 121 patients with symptomatic POP (POP-Q Ⅱ-Ⅳ) came to our hospital for treatment from December,2015 to June,2017 were selected as study objects,and were divided into a silicone pessary group and a surgery group according to the treatment methods.The surgery included laparoscopic vaginal sacral fixation,vaginal mesh implantation,vaginal or laparoscopic hysterectomy,suspension of sacral ligament,anterior and/or posterior colporrhaphy,and colpocleisis.The outcomes were evaluated and compared before and 1 year after the treatment using PFDI-20 and PFIQ-7.Results Among the 121 patients,53 chose silicone pessary treatment and 45 continuously used pessary for 1 year;and 68 chose surgical treatment.113 patients completed questionnaires.There were no statistical differences in PFDI-20 and PFIQ-7 between the two groups before the treatment (all P ＞ 0.05).There were statistical differences in PFDI-20 and PFIQ-7 between before and after the treatment in both groups (all P ＜ 0.05).Improvement was noted in prolapse of vaginal masses and urinary symptoms.There were no statistical differences in PFDI-20 and PFIQ-7 between the two groups 1 year after the treatment (P ＞ 0.05) Conclusion Silicone pessary can significantly improve the vaginal and urinary symptoms of POP.The improvement of quality of life after conservation treatment is consistent with that after operation.The initial treatment of POP with silicone pessaries is recommended.%目的 应用《盆底症状问卷调查表-简要版》(PFDI-20)和《盆底疾病对病人的影响问卷调查表》(PFIQ-7)比较硅胶子宫托和手术治疗女性盆腔器官脱垂的疗效.方法 选取2015年12月至2017年6月就诊于广东省妇幼保健院有症状、要求治疗的121例POP-QⅡ～Ⅳ度的患者为研究对象.按治疗方式分为硅胶子宫托组和手术组,手术方式包括腹腔镜下Y形网片阴道骶骨固定术,阴道植入盆底网片,阴式或腹腔镜下子宫切除高位骶韧带悬吊加阴道前后壁修补术及阴道封闭术;对患者治疗前、治疗后1年的PFDI-20和PFIQ-7调查问卷评分进行组间、组内比较.结果 121例POP患者中,自愿选择硅胶子宫托者53例,1年佩戴成功45例,手术者68例,共113例患者完成问卷调查.两组治疗前PFDI-20、PFIQ-7比较差异均无统计学意义(均P＞ 0.05);组内比较:治疗后1年与治疗前差异均有统计学意义(均P＜ 0.05),其中阴道肿物脱出及泌尿道症状缓解明显;治疗后1年组间比较差异无统计学意义(P＞0.05).结论 硅胶子宫托治疗POP可以明显改善脱垂及相应的泌尿生殖道症状,保守治疗后患者生活质量提高与手术治疗后一致;对于POP初始治疗硅胶子宫托是一种值得推荐的治疗方法.