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目的探讨经阴道坐骨棘筋膜固定缝合术(ischial spinous fascia fixation,ISFF)与骶棘韧带固定术(sacrospinous ligament fixation,SSLF)治疗子宫脱垂的有效性和安全性。方法选取2010年3月至2016年1月在佛山市妇幼保健院治疗的子宫脱垂患者34例,采用双盲法随机分为两组,分别实施ISFF(18例)和SSLF(16例)两种术式,采用盆腔器官脱垂定量分期法评估两组手术治疗效果。结果 ISFF组和SSLF组术中出血量分别为(50±10.5)m L、(92±8.2)m L,手术时间分别为(60±8.6)min、(74±9.6)min;术后住院时间分别为(4.2±0.8)d、(4.5±1)d。术前ISFF组患者子宫C点(+2.60±0.20)cm、D点(-3.91±0.61)cm;SSLF组C点(+2.61±0.13)cm、D点(-3.89±1.20)cm。术后检查ISFF组患者C点(-5.69±0.51)cm、D点(-6.87±0.32)cm;SSLF组C点(-5.70±0.60)cm、D点(-7.00±0.30)cm;两组手术前后比较差异均有统计学意义(P<0.05),但两组间治疗效果比较差异无统计学意义(P>0.05)。术后随访24个月,最后有6例患者失访。术后3月随访28例患者有正常性生活,6例患者因自身原因拒绝性生活。结论 ISFF是利用自身组织治疗子宫脱垂,具有治愈率高、复发率低、费用低,安全微创、术后对性生活影响小等优点。
Objective To investigate the efficacy and safety of transvaginal ischial spinous fascia fixation (ISFF) and sacrospinous ligament fixation (SSLF) in the treatment of uterine prolapse. Methods From March 2010 to January 2016, 34 cases of uterine prolapse treated in Foshan MCH were randomly divided into two groups: ISFF (18 cases) and SSLF (16 cases) Surgical procedures, the use of pelvic organ prolapse quantitative staging method to evaluate the two groups of surgical treatment. Results The blood loss in the ISFF and SSLF groups was (50 ± 10.5) m L and (92 ± 8.2) m L, respectively, and the operative time was (60 ± 8.6) min and (74 ± 9.6) min respectively. Respectively, (4.2 ± 0.8) d, (4.5 ± 1) d. In the preoperative ISFF group, the uterus in C group was (+ 2.60 ± 0.20) cm and D (-3.91 ± 0.61) cm respectively, while in SSLF group, C was (+2.61 ± 0.13) cm and D was (-3.89 ± 1.20) cm. The postoperative CIF value in the ISFF group was -5.69 ± 0.51 cm and -6.87 ± 0.32 cm, in the SSLF group, it was -5.70 ± 0.60 cm in the SSLF group and -7.00 ± 0.30 cm in the D group The difference was statistically significant before and after surgery (P <0.05), but there was no significant difference between the two groups in the treatment effect (P> 0.05). The patients were followed up for 24 months. Finally, 6 patients were lost to follow-up. 28 patients were followed up for normal life after 3 months and 6 patients refused sexual life for their own reasons. Conclusion ISFF is the use of its own tissue treatment of uterine prolapse, with a high cure rate, low recurrence rate, low cost, safe minimally invasive, postoperative impact on sexual life is small and so on.