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目的探讨宫颈穹窿化技术在保留子宫的全盆底重建手术中的应用价值。方法选取2011年1月至2012年1月因患有Ⅲ~Ⅳ度盆腔器官脱垂,于中国医科大学附属盛京医院接受植入网片保留子宫的全盆底重建手术治疗患者109例作为研究对象。其中观察组,保留子宫同时增加“宫颈穹窿化”术式的全盆底重建手术,共50例;对照组,保留子宫的传统全盆底重建手术,共59例。两组患者术前一般情况,术前POP-Q分期,围手术期情况比较,差异无统计学意义。结果术后随访POP-Q分期,观察组与对照组C点位置[6个月(-6.75±1.83)cm对(-4.63±1.07)cm,12个月(-6.75±1.83)cm对(-4.03±1.57)cm,18个月(-7.01±1.83)cm对(4.03±1.77)cm]、D点位置[6个月(-7.13±1.41)cm对(-5.00±1.41)cm,12个月(-7.12±1.41)cm对(-4.52±1.51)cm,18个月(-7.13±1.41)cm对(4.02±1.81)cm],差异均有统计学意义(P<0.05);观察组阴道总长度(TVL)明显长于对照组[6个月(8.13±0.64)cm对(7.00±0.76)cm,12个月(8.13±0.64)cm对(6.50±0.56)cm,18个月(8.13±0.64)cm对(6.50±0.56)cm;均P<0.05]。结论通过在保留子宫的盆底重建术中加入“宫颈穹窿化技术”提高了宫颈、穹窿位置,延长了阴道长度,最大限度的预防了全盆底重建术后宫颈延长、穹窿脱垂或子宫脱垂等复发情况的发生。
Objective To investigate the value of cervical canalization in the preservation of the uterus in pelvic floor reconstruction. Methods From January 2011 to January 2012, 109 patients with pelvic floor reconstruction undergoing surgical implantation of the uterus by mesh placement in Shengjing Hospital affiliated to China Medical University were studied for pelvic organ prolapse with grade Ⅲ ~ Ⅳ. Object Among them, the observation group, while keeping the uterus, increased the number of “pelvic floor dome reconstruction” operation, a total of 50 cases; control group, retaining the uterus traditional pelvic floor reconstruction surgery, a total of 59 cases. The two groups of patients before surgery in general, preoperative POP-Q staging, perioperative period, the difference was not statistically significant. Results The postoperative follow-up of POP-Q staging was as follows: the location of point C in the observation group and the control group (-6.75 ± 1.83 cm vs -4.63 ± 1.07 cm vs 12 months (-6.75 ± 1.83) cm vs 4.03 ± 1.57) cm and (-7.01 ± 1.83) cm vs (4.03 ± 1.77) cm, respectively, while the position of D at 6 months (-7.13 ± 1.41 cm vs -5.00 ± 1.41 cm vs 12 (-7.12 ± 1.41) cm vs (-4.52 ± 1.51) cm and 18 months (-7.13 ± 1.41) cm vs (4.02 ± 1.81) cm respectively. The difference was statistically significant (P <0.05) The total length of the vagina (TVL) was significantly longer than that of the control group [6 months (8.13 ± 0.64) cm vs 7.00 ± 0.76 cm vs 12 months (8.13 ± 0.64) cm vs 6.50 ± 0.56 cm vs 18 months ± 0.64) cm vs (6.50 ± 0.56) cm respectively; all P <0.05]. CONCLUSIONS: Cervical vault technique is used to improve the position of cervix and vault by prolonging the length of the vagina by adding “cervical vault technique” in pelvic floor reconstruction to preserve the uterus, and to prevent the cervical extension, vault prolapse or Uterine prolapse and other recurrence of the occurrence.