本文關鍵詞：對盆底重建術與腹腔鏡陰道骶骨固定術治療盆腔臟器脫垂的綜合評價　出處：《青島大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 盆腔臟器脫垂 腹腔鏡陰道骶骨固定術 全盆底重建術

【摘要】：目的:探究盆底重建術與腹腔鏡陰道骶骨固定術治療盆腔臟器脫垂的臨床療效及安全性,比較兩術式的優(yōu)劣及適應癥,以期為臨床實踐提供理論基礎。方法:回顧性統(tǒng)計分析自2013年9月至2016年9月因盆腔臟器脫垂于青島大學附屬醫(yī)院婦科行手術治療的103例患者的相關資料,其中行盆底重建術者62例(均為全盆重建術),行腹腔鏡下陰道骶骨固定術者41例(術中均同時切除子宮),對比兩組患者圍手術期相關臨床資料、并發(fā)癥及術后隨訪資料,探究兩種手術方式的安全性及臨床療效。本研究中的所有數(shù)據(jù)采用SPSS 19.0軟件進行統(tǒng)計學分析。結(jié)果:1、基本資料分析:盆底重建組患者平均年齡為62.85±8.74歲,高于骶骨固定組(56.37±11.62歲,P0.05),而兩組患者在孕產(chǎn)次、體質(zhì)指數(shù)及是否合并內(nèi)科疾病及壓力性尿失禁等的比較中未見統(tǒng)計學差異。2、手術相關參數(shù)比較:盆底重建組患者的平均手術時間為94.37±32.63min,明顯低于腹腔鏡下骶骨固定組(157.64±41.28min),而且該組患者術中出血量也明顯少于骶骨固定組(35.63±15.45vs 75.57±30.77ml),差異均有統(tǒng)計學意義(P0.05)。兩組患者術后尿管留置時間、住院天數(shù)及手術費用的比較中未見統(tǒng)計學差異。3、圍手術期并發(fā)癥:盆底重建組圍手術期共有3例患者出現(xiàn)手術相關并發(fā)癥,發(fā)生率為4.84%(3/62),與骶骨固定組相比(4.87%,2/41),兩組間差異沒有統(tǒng)計學意義。兩組患者術中均未發(fā)生盆腔重要臟器、大血管及神經(jīng)損傷。4、網(wǎng)片相關并發(fā)癥:隨訪61例盆底重建患者,均未發(fā)生網(wǎng)片暴露,但有2例患者術后表現(xiàn)慢性盆腔疼痛(3.27%,2/61);而骶骨固定組中有2例患者出現(xiàn)網(wǎng)片暴露(5%,2/40),未發(fā)生慢性盆腔疼痛的情況,差異有統(tǒng)計學意義(P0.05)。5、隨訪資料分析:103例患者中有101例患者完成術后隨訪(98%)。兩組患者術后POP-Q評分均較術前明顯改善,客觀治愈率均為100%,且隨訪期間均無復發(fā)。兩組患者術前與術后半年PFDI-20評分及PFDI-7評分均較前明顯好轉(zhuǎn),差異有統(tǒng)計學意義(P0.05),而兩組間評分則無顯著差異。兩組患者性生活質(zhì)量評分(PISQ-12)存在顯著差異,其中骶骨固定組患者評分(79.8±4.6)明顯高于盆底重建組(61.6±10.2)。兩組患者術后新發(fā)尿失禁情況無明顯差異。結(jié)論:盆底重建術及腹腔鏡陰道骶骨固定術均療效明確、并發(fā)癥低,是治療盆腔臟器脫垂安全、有效的手術方式。兩術式各有利弊,臨床工作中,應根據(jù)患者的意愿、年齡、臟器脫垂的程度、患者對性生活的要求度以及患者的經(jīng)濟條件等因素進行綜合考慮,從而實現(xiàn)個體化手術方式。
[Abstract]:Objective: to investigate the clinical efficacy and safety of pelvic floor reconstruction and laparoscopic vaginal sacral fixation in the treatment of pelvic organ prolapse. Methods:. From September 2013 to September 2016, the data of 103 patients undergoing gynecological surgery for pelvic viscera prolapse in the affiliated hospital of Qingdao University were analyzed retrospectively. Among them, 62 cases underwent pelvic floor reconstruction (total pelvic reconstruction) and 41 cases underwent laparoscopic vaginal sacrum fixation. Complications and postoperative follow-up data to explore the safety and clinical efficacy of the two surgical methods. All the data in this study were statistically analyzed by SPSS 19.0 software. Results: 1. Analysis of basic data: the average age of pelvic floor reconstruction group was 62.85 鹵8.74 years old, which was higher than that of sacral fixation group (56.37 鹵11.62 years old) (P 0.05). There was no significant difference in body mass index (BMI) and stress urinary incontinence between internal diseases and stress urinary incontinence. Comparison of operative parameters: the mean operation time of pelvic floor reconstruction group was 94.37 鹵32.63 min, which was significantly lower than that of laparoscopic sacral fixation group (157.64 鹵41.28 min). The amount of intraoperative bleeding in this group was significantly lower than that in the sacral fixation group (35.63 鹵15.45 vs 75.57 鹵30.77 ml). The difference was statistically significant (P 0.05). There was no statistical difference between the two groups in the time of indwelling urinary catheter, the days of hospitalization and the cost of operation. Perioperative complications: in pelvic floor reconstruction group, there were 3 cases of perioperative complications, the incidence was 4.84 / 62%, compared with the sacral fixation group, 4.87% of 41). There was no significant difference between the two groups. During the operation, there were no major pelvic organs, large vessels and nerve injury .4. net related complications: 61 cases of pelvic floor reconstruction patients were followed up, none of them had any net exposure. But there were 2 patients with chronic pelvic pain who had 2 / 61s of chronic pelvic pain. In the sacral fixation group, there were 2 cases with net exposure of 5 / 40%, and no chronic pelvic pain occurred. The difference was statistically significant (P 0.05). Follow-up data analysis: 101 out of 103 patients were followed up after operation. The POP-Q scores of the two groups were significantly improved compared with those before operation, and the objective cure rate was 100%. There was no recurrence during the follow-up period. The PFDI-20 score and PFDI-7 score of the two groups were significantly improved before and after operation (P 0.05). However, there was no significant difference in scores between the two groups, but there was a significant difference in the scores of sexual life quality and PISQ-12 between the two groups. The score of sacral fixation group (79.8 鹵4.6) was significantly higher than that of pelvic floor reconstruction group (61.6 鹵10.2). Conclusion: pelvic floor reconstruction and laparoscopic vaginal sacral fixation are effective. The complications are low, which is a safe and effective way to treat pelvic organ prolapse. There are advantages and disadvantages between the two methods. In clinical work, according to the wishes of patients, age, organ prolapse degree. In order to realize the individualized operation mode, the factors such as the requirement of sexual life and the economic condition of the patients were comprehensively considered.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R713

【參考文獻】

相關期刊論文 前10條

1 曲思嬈;李芳;趙曼曼;;陰式骶棘韌帶固定術治療子宮脫垂的效果觀察[J];中國現(xiàn)代藥物應用;2017年01期

2 王益勤;楊欣;王建六;;盆底重建術后合成網(wǎng)片或吊帶相關疼痛的處理和結(jié)局分析[J];中華婦產(chǎn)科雜志;2016年12期

3 婁艷輝;崔竹梅;田靜;相麗;金秋利;劉吉紅;;網(wǎng)片重建治療盆腔器官脫垂的臨床療效及安全性評價[J];現(xiàn)代生物醫(yī)學進展;2016年13期

4 顧雪芬;陳紅玲;康琳;黃細英;邱銀;江成林;;圍絕經(jīng)期盆底康復聯(lián)合中藥及雌激素治療盆底器官脫垂的臨床療效分析[J];中外醫(yī)療;2014年20期

5 陳忠;;女性壓力性尿失禁的診治進展[J];中華臨床醫(yī)師雜志(電子版);2014年03期

6 劉靜;孫文紅;吳鳳英;鄧朝紅;王華;張麗紅;;盆底重建術治療重度盆腔臟器脫垂療效評價[J];中國傷殘醫(yī)學;2013年09期

7 楊欣;王建六;;正確認識美國FDA對經(jīng)陰道使用網(wǎng)片安全性及有效性的警示[J];中國婦產(chǎn)科臨床雜志;2013年02期

8 吳志芬;宋巖峰;黃惠娟;李寶恒;吳燕青;;盆底重建手術治療盆腔器官脫垂的臨床研究[J];中國婦產(chǎn)科臨床雜志;2012年02期

9 游珂;韓勁松;顧方穎;王秀云;高榮蓮;張璐芳;;傳統(tǒng)陰式手術治療盆腔臟器脫垂術后療效研究[J];中國微創(chuàng)外科雜志;2007年12期

10 王玉珍;楊萍;梁志清;;盆底器官脫垂及其病因?qū)W研究進展[J];西北國防醫(yī)學雜志;2006年03期

，

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