腹腔镜环宫颈子宫骶骨固定术疗效评估和生活质量评价

曹变娜　郭久柏　吴斐　罗美

【摘要】 目的：探討并评价腹腔镜环宫颈子宫骶骨固定手术（LCSH）对中盆腔脏器脱垂患者症状和生活质量的影响，评估该手术的有效性和安全性。方法：回顾性分析2016年12月-2018年3月在本院因重度中盆腔脏器脱垂行LCSH的患者30例的临床资料。观察围术期情况，比较手术前后盆腔器官脱垂定量分期法（POP-Q）各指示点位置、生活质量（PFDI-20），观察解剖治愈、失败及复发情况。

结果：30例患者均顺利完成手术，平均手术时间（101.90±25.35）min;平均术中出血量50（30）mL;平均留置尿管时间（1.77±0.42）d;患者术后恢复良好，平均术后住院时间（3.97±0.75）d;平均随访（7.65±2.61）个月;无术中及术后严重并发症;解剖学治愈率100%，无复发、失败病例;患者手术前后各指示点位置比较，差异均有统计学意义（P<0.001）;患者术后末次随访时的PFDI-20、POPDI-6、UDI-6评分均低于术前（P<0.001）;手术前后CRADI-8评分比较，差异无统计学意义（P>0.05）。

结论：LCSH适用于要求保留子宫的中盆腔器官脱垂患者，尤其是年轻女性，网片放置位置更低，手术难度降低、手术时间缩短，解剖学治愈率高，不仅能较好达到解剖学复位，还能达到较好的功能学复位，显著改善患者的生活质量，患者及配偶术后性生活满意度较高。

【关键词】 中盆腔器官脱垂; 子宫脱垂; 腹腔镜环宫颈子宫骶骨固定术

【Abstract】 Objective：To evaluate the effect of laparoscopic cerclage sacrohysteropexy for mid-pelvic organ prolapsed patients clinical symptoms and quality of life（QOL），to assess the effectiveness and safety.

Method：The clinical data of 30 patients with severe mid-pelvic organ prolapsed undergoing LCSH from December 2016 to March 2018 were retrospectively analyzed.The perioperative period was observed，the location of POP-Q and quality of life（PFDI-20）were compared before and after operation，anatomical cure，failure and recurrence were observed.Result：The average operation time was（101.90±25.35）min，the average intraoperative bleeding volume was

50（30）mL，the average indwelling catheter time was（1.77±0.42）d，the patients recovered well after operation with an average hospitalization time of（3.97±0.75）d，the average follow-up time was（7.65±2.61）months，there were no serious complications during and after operation，the anatomical cure rate was 100%，no recurrence or failure cases.The position of indicating points before and after operation were compared，the differences were statistically significant（P<0.001）.The PFDI-20，POPDI-6 and UDI-6 scores at the last follow-up after operation were lower than those of before operation（P<0.001），but the CRADI-8 score before and after operation was compared，the difference was not statistically significant（P>0.05）.Conclusion：LCSH suitable for mid-pelvic organ prolapsed patients who require the retention of the uterus，especially young women，the placement of the mesh is lower，the difficulty of operation is reduced，the time of operation is shortened，and the cure rate of anatomy is high，it can not only achieve better anatomical reduction，but also achieve better functional reduction，it can significantly improve the quality of life of patients，the satisfaction of sexual life of patients and spouses after operation is higher.