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目的探讨经腹腔镜与经腹行阴道顶端骶骨悬吊术治疗盆腔器官脱垂的可行性、安全性,并比较两种术式的优劣。方法回顾性分析郑州大学第一附属医院2011年2月至2012年6月行阴道顶端骶骨悬吊术患者共31例,其中20例行经腹腔镜手术(观察组),11例行经腹手术(对照组),比较两组患者术前一般情况、围术期及术后随访情况。结果两组患者术前一般情况无明显差异。观察组1例因盆腔粘连严重中转开腹。两组主客观治愈率均为100%,术中均无并发症发生。术后开腹组1例出现盆腹腔感染;随访期间腹腔镜组1例缝线断裂,开腹组1例补片侵蚀暴露,1例新发压力性尿失禁;治疗后均得以痊愈。比较发现腹腔镜组较开腹手术组具有术中出血量少、术后疼痛轻、发热人数少、恢复快、排尿排气早、住院时间短等优点。但手术时间长于开腹组。结论腹腔镜下阴道顶端骶骨悬吊术是安全可行的,且较开腹手术具有术中出血少、术后疼痛轻、发热人数少、恢复快、排尿排气早、住院时间短等优点。
Objective To investigate the feasibility and safety of trans-laparoscopic and transabdominal vaginal top sacral suspensions for the treatment of pelvic organ prolapse. The pros and cons of the two procedures were compared. Methods A retrospective analysis of 31 patients with vaginal sacral suspensions performed at the First Affiliated Hospital of Zhengzhou University from February 2011 to June 2012 was performed. Among them, 20 patients underwent laparoscopic surgery (observation group) and 11 underwent abdominal transabdominal surgery (Control group). The general condition, perioperative period and postoperative follow-up of the two groups were compared. Results There was no significant difference in the general condition between the two groups before operation. In the observation group, 1 patient underwent pelvic adhesion serious conversion laparotomy. Both subjective and objective cure rates were 100%, no intraoperative complications. One patient had abdominal pelvic infection after operation. One patient underwent laparoscopic suture rupture in open group, one patient under open laparotomy and one new stress urinary incontinence after operation. All patients were cured after treatment. Compared with the laparotomy group, laparoscopic group showed less intraoperative blood loss, less postoperative pain, less fever, faster recovery, earlier urination and discharge, shorter hospital stay and so on. However, the operation time was longer than that of the open group. Conclusions Laparoscopic vaginal top sacral suspension is safe and feasible. Compared with laparotomy, it has less intraoperative bleeding, less postoperative pain, fewer fever, faster recovery, earlier urination and discharge, shorter hospital stay and so on.