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目的:探讨行子宫切除术的同时,利用残留的骶、主韧带行多点悬吊术重建阴道环在治疗I度盆腔器官脱垂中的疗效及其对患者术后生活质量的影响。方法:选取子宫良性病变合并I度盆腔器官脱垂(POP)的45例患者,其中25例行经腹全子宫切除术+骶主韧带多点悬吊术重建阴道环(悬吊组),20例行经腹子宫全切术(对照组)。术前及术后1月、3月、6月根据POP-Q分度、阴道长度等指标判断治疗疗效,生活质量问卷(PFID-20)评估患者的生活质量。结果:悬吊组与对照组的疾病分布、年龄、产次、术前POP-Q分度、术前PFID-20评分、平均手术时间和术中出血量等均无显著差异(P>0.05)。术后1月、3月、6月,悬吊组C点测量值分别为-8.4±0.72、-8.0±0.72和-8.0±0.72,对照组分别为-5.3±0.57、-5.3±0.57和-5.0±0.43,两组比较差异显著(P<0.05);悬吊组Aa点测量值分别为-2.1±0.78、-2.0±0.70和-2.0±0.70,对照组分别为-0.66±0.57、-0.67±0.57和-0.67±0.51,两组比较差异显著(P<0.05);悬吊组Ba点测量值分别为-2.44±0.52、-2.44±0.52和-2.33±0.50,对照组分别为-2.00±0.00、-2.00±0.00和-1.33±0.50,两组比较差异显著(P<0.05);悬吊组Ap点测量值分别为-2.3±0.54、-2.4±0.38和-2.4±0.58,对照组分别为-0.5±0.86、-0.67±1.0和-0.69±1.0,两组比较差异显著(P<0.05);悬吊组Bp点测量值分别为-2.5±0.47、-2.4±0.42和-2.5±0.42,对照组分别为-1.0±0.00、-1.0±0.00和-1.1±0.28,两组比较差异显著(P<0.05)。悬吊组的生活质量问卷评分分别为20.77±23.7、9.89±9.13和9.44±9.54,对照组分别为62.5±10.6、67.6±2.08和53.6±8.5,两组比较差异显著(P<0.05)。结论:骶主韧带多平面悬吊术可重建阴道环代替宫颈环的盆底支持作用,临床治疗Ⅰ度盆腔器官脱垂疗效肯定,副作用少。
OBJECTIVE: To explore the curative effect of vaginal ring reconstruction in treating I degree pelvic organ prolapse with residual sacral and main ligament multi-point suspension and its effect on postoperative quality of life. METHODS: Forty-five patients with benign uterine disease and I degree pelvic organ prolapse (POP) were selected. Twenty-five of them underwent hysterectomy plus sacral main ligament multipoint suspension to reconstruct the vaginal ring (suspension group), 20 Routine transabdominal hysterectomy (control group). Preoperative and postoperative January, March and June according to POP-Q index, vaginal length and other indicators to determine the efficacy of treatment, quality of life questionnaire (PFID-20) to assess the quality of life of patients. Results: There was no significant difference in disease distribution, age, parity, preoperative POP-Q index, preoperative PFID-20 score, mean operative time and intraoperative blood loss between the suspension group and the control group (P> 0.05) . The measured values of point C in the suspension group were -8.4 ± 0.72, -8.0 ± 0.72 and -8.0 ± 0.72 respectively at January, March and June after operation, while those in the control group were -5.3 ± 0.57 and -5.3 ± 0.57 and - 5.0 ± 0.43, the difference between the two groups was significant (P <0.05). The measured values of Aa in the suspension group were -2.1 ± 0.78, -2.0 ± 0.70 and -2.0 ± 0.70 respectively, while the control group were -0.66 ± 0.57 and -0.67 ± 0.57 and -0.67 ± 0.51 respectively, the difference between the two groups was significant (P <0.05). The measured values of Ba in the suspension group were -2.44 ± 0.52, -2.44 ± 0.52 and -2.33 ± 0.50, respectively, while those in the control group were -2.00 ± 0.00, -2.00 ± 0.00 and -1.33 ± 0.50, respectively, with significant difference between the two groups (P <0.05). The measured values of Ap in the suspension group were -2.3 ± 0.54, -2.4 ± 0.38 and -2.4 ± 0.58, respectively Were -0.5 ± 0.86, -0.67 ± 1.0 and -0.69 ± 1.0, respectively, with significant differences between the two groups (P <0.05). The measured Bp values in the suspension group were -2.5 ± 0.47, -2.4 ± 0.42 and -2.5 ± 0.42 , The control group was -1.0 ± 0.00, -1.0 ± 0.00 and -1.1 ± 0.28 respectively, the difference between the two groups was significant (P <0.05). The quality of life questionnaire of the suspension group were 20.77 ± 23.7,9.89 ± 9.13 and 9.44 ± 9.54 respectively, while the control group were 62.5 ± 10.6,67.6 ± 2.08 and 53.6 ± 8.5, respectively. There was significant difference between the two groups (P <0.05). Conclusion: The multi-plane sacral ligament suspension can be reconstructed vaginal ring instead of the cervical support of the pelvic floor, clinical treatment of pelvic organ prolapse Ⅰ degree of efficacy with fewer side effects.