目的:探讨腹腔镜下全子宫切除联合阴道残端腹壁悬吊术在治疗中重度子宫脱垂患者的临床应用情况。方法:回顾性分析2021年1月至2023年4月在巴彦淖尔市医院接受腹腔镜下全子宫切除联合阴道残端腹壁悬吊术治疗中重度子宫脱垂60例患者临床资料,根据手术时间、术中出血量、住院时间、术后并发症发生率以及术后12个月随访情况,评估此术式的临床应用情况。结果:60例患者均顺利完成腹腔镜下全子宫切除联合阴道残端腹壁悬吊术,平均手术时间为(90.2±12.5)min,平均术中出血量为(50.8±14.6)mL,平均住院时间为(5.1±1.4)d;2例出现术后并发症,其中1例阴道残端感染,1例短暂性尿潴留,并发症发生率为3.3%(2/60)。所有患者分别在术后1、3、6、12个月进行电话及门诊随访,其中术后12个月失访2例,其余58例患者均未出现子宫脱垂复发,且随着时间的推移,患者的情况逐渐达标,相较术前生活质量得到提升(P＜0.05);患者术后症状改善,总体满意度评分较高。结论:腹腔镜下全子宫切除联合阴道残端腹壁悬吊术是治疗中重度子宫脱垂的有效手术方法,随着时间推移,患者术后症状改善、生活质量、满意度均较好。
Objective:To investigate the clinical effect of laparoscopic total hysterectomy combining with vaginal stump suspension in the treatment of moderate and severe uterine prolapse. Methods: The clinical data of 60 patients with moderate and severe uterine prolapse who underwent laparoscopic hysterectomy combining with vaginal stump suspension in Banyannur Hospital from January 2021 to April 2023 were retrospectively analyzed. The clinical efficacy of this surgical method was evaluated based on the operative time, intraoperative blood loss, length of hospital stay(LOS), postoperative complications and results of 12-month follow-up. Results: All surgeries were successfully completed, with the average operative time of (90.2±12.5) min, the average intraoperative blood loss of (50.8±14.6) mL, and the average LOS of (5.1±1.4) d. There were 1 case of vaginal stump infection and 1 case of transient urinary retention, and the complication rate was 3.3% (2/60). All patients were followed up at 1 month, 3 months, 6 months and 12 months after surgery by telephone and outpatient examination. Among them, 2 cases were lost to follow-up at 12 months, and no recurrence of uterine prolapse occurred in the remaining 58 patients. With the passage of time, the patient's condition gradually reached the normal standard, and the quality of life was significantly improved compared with that before surgery (P＜0.05). The overall satisfaction and postoperative symptoms were significantly improved. Conclusion: Laparoscopic hysterectomy combining with vaginal stump suspension is an effective surgical method in treating moderate and severe uterine prolapse, which has the advantages of shorter operative time, less intraoperative bleeding, faster postoperative recovery and fewer complications. With the passage of time, the postoperative symptoms, quality of life and satisfaction of patients were significantly improved.
[1] Huang KJ, Lin KT, Wu CJ, et al. Single incision laparoscopic surgery using conventional laparoscopic instruments versus two-port laparoscopic surgery for adnexal lesions[J]. Sci Rep, 2021, 11(1): 4118.
[2] 张波, 孙博, 梁宗康, 等. 腹腔镜手术技能评价工具的发展与现状[J/OL]. 腹部外科. https://link. cnki. net/urlid/42. 1252. R. 20240320. 1307. 002.
[3] 茅国琴, 许建英, 顾家频. 腹腔镜下全子宫切除术联合阴道残端腹壁悬吊术治疗中重度子宫脱垂的效果[J]. 实用妇科内分泌电子杂志, 2023, 10(32): 22-24.
[4] Andebrhan SB, Caron AT, Szlachta-McGinn A, et al. Pelvic organ prolapse recurrence after pregnancy following uterine-sparing prolapse repair: a systematic review and meta-analysis[J]. Int Urogynecol J, 2023, 34(2): 345-356.
[5] Hsiao SM, Chang TC, Chen CH, et al. Risk factors for coexistence of cervical elongation in uterine prolapse[J]. Eur J Obstet Gynecol Reprod Biol, 2018, 229: 94-97.
[6] 王玉梅, 汪香梅, 王艳. 腹腔镜下阴道骶骨固定术治疗中重度子宫脱垂对患者盆底功能恢复及生活质量影响[J]. 中国计划生育学杂志, 2023, 31(9): 2054-2058.
[7] 龚梦, 申复进, 许学先. 开腹与腹腔镜下筋膜内全子宫切除术对盆腔器官脱垂的影响[J]. 中国妇产科临床杂志, 2022, 23(6): 624-625.
[8] Anand M, Weaver AL, Fruth KM, et al. Perioperative complications and cost of vaginal, open abdominal, and robotic surgery for apical vaginal vault prolapse[J]. Female Pelvic Med Reconstr Surg, 2017, 23(1):27-35.
[9] Xu HG, Ding HY, Shi C, et al. Meta-analysis of the efficacy of laparoscopic uterosacral ligament suspension in patients with pelvic organ prolapse[J]. J Gynecol Obstet Hum Reprod, 2023, 52(10): 102634.
[10] Brito LG, Cohen SL, Tusheva O, et al. Surgical outcomes of a combined surgical approach for apical prolapse repair[J]. Rev Bras Ginecol Obstet, 2016, 38(8): 405-411.
[11] 王昕钰. 女性盆底器官中重度脱垂术式对临床疗效的探讨[D]. 郑州: 郑州大学, 2022.
[12] Peng J, Li SQ, Wang LW, et al. Comparison of efficacy between laparoscopic pectopexy and laparoscopic high uterosacral ligament suspension in the treatment of apical prolapse-short term results[J]. Sci Rep, 2023, 13(1): 18519.
[13] 陈萍. 阴道残端髂耻韧带悬吊术联合腹腔镜下子宫切除术治疗子宫脱垂的效果[J]. 包头医学, 2023, 47(2): 7-9.
[14] 樊燕燕, 李爽. 腹腔镜子宫悬吊术联合阴道前后壁修补术治疗子宫脱垂合并阴道前后壁膨出患者的效果[J]. 中国民康医学, 2023, 35(11): 58-60.
[15] 李文学, 陈秀娟, 秦玉静. 腹腔镜腹膜外子宫悬吊联合阴道前壁修补术在前中盆腔脏器脱垂中的临床疗效[J]. 中国处方药, 2023, 21(8): 29-34.
