發(fā)布時(shí)間：2018-05-30 11:43

  本文選題：腹腔鏡骶骨陰道固定術(shù) + 盆腔器官脫垂��； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：評(píng)估腹腔鏡骶骨陰道固定術(shù)(laparoscopic sacral colpopexy，LSC)治療盆腔器官脫垂(pelvic organ prolapse，POP)的臨床療效及安全性。 方法：回顧性分析2008年11月至2014年2月在河北醫(yī)科大學(xué)第二醫(yī)院由同一醫(yī)生完成LSC治療的29例中、重度POP患者的臨床資料。應(yīng)用盆腔器管脫垂定量分期法(pelvic organ prolapse quantitation，POP-Q)對(duì)POP患者進(jìn)行分度，使用盆底功能障礙性疾病癥狀問(wèn)卷簡(jiǎn)表(pelvic floordistress inventory-short form20，PFDI-20)和盆底疾病生活質(zhì)量影響問(wèn)卷短表(pelvic floor impact questionnaire-short form7，PFIQ-7)評(píng)估患者癥狀和健康相關(guān)生活質(zhì)量（health-related quality of life，HRQL)，采用POP/尿失禁性生活問(wèn)卷（pelvic organ prolapse-urinary incontinence sexualquestionnaire，PISQ-12)評(píng)估患者的性生活質(zhì)量。術(shù)后1月、6月、12月及每年進(jìn)行隨訪，將隨訪結(jié)果與術(shù)前數(shù)據(jù)進(jìn)行比較，評(píng)估LSC的手術(shù)療效。同時(shí)觀察手術(shù)時(shí)間、術(shù)中出血等指標(biāo)，記錄住院費(fèi)用等綜合評(píng)估手術(shù)安全性和經(jīng)濟(jì)負(fù)擔(dān)。 結(jié)果：平均手術(shù)時(shí)間為228.1±35.2min(130~280min)，，術(shù)中平均出血量120.0±76.0ml(50~400ml)，術(shù)后體溫超過(guò)38.5℃者2例（6.9%，2/29），術(shù)后平均留置尿管3.0±1.1d (2~7d)，術(shù)后平均住院時(shí)間4.9±1.1d(4~5d)，住院總費(fèi)用22170.5±5410.3元。29例患者隨訪1~64個(gè)月，中位隨訪時(shí)間14.0個(gè)月，術(shù)后6月、12月POP-Q各指示點(diǎn)位置與術(shù)前相比得到明顯改善(P0.05)，術(shù)后6月與12月結(jié)果之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)，解剖學(xué)上LSC術(shù)后陰道頂端得到良好復(fù)位，僅有1例患者出現(xiàn)陰道前壁脫垂Ⅱ度，客觀治愈率96.6%（28/29）。PFDI-20、PFIQ-7和PISQ-12評(píng)分術(shù)前分別為101.9±13.4、98.2±11.9、20.6±1.8，術(shù)后6個(gè)月分別為38.4±19.7、12.8±6.6、22.7±2.8，術(shù)后12個(gè)月分別為39.9±18.7、13.3±6.2、23.4±2.6，術(shù)后6月與術(shù)后12月各評(píng)分分別與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)，術(shù)后6月與術(shù)后12月各評(píng)分之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。有1例患者發(fā)生術(shù)中穿透骶中靜脈，經(jīng)骨蠟等壓迫止血后好轉(zhuǎn)。1例（3.4%）術(shù)后新發(fā)SUI。5例術(shù)前排便困難或便秘，術(shù)后1個(gè)月內(nèi)癥狀仍明顯，其中3例在術(shù)后6個(gè)月緩解。術(shù)后新發(fā)便秘者2例（6.9%），其中1例術(shù)后3月內(nèi)緩解。1例術(shù)后性交不適，經(jīng)心理疏導(dǎo)后緩解�？偟闹饔^治愈率86.2%（25/29）。隨訪期間，未見(jiàn)網(wǎng)片侵蝕、暴露、感染等并發(fā)癥。 結(jié)論: LSC是一種微創(chuàng)、安全、有效的手術(shù)方式，主、客觀治愈率高，不僅能達(dá)到解剖學(xué)復(fù)位，還能顯著改善患者癥狀、生活質(zhì)量和性生活質(zhì)量。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of laparoscopic sacral colpopexy (LSC) in the treatment of pelvic organ prolapse (POP). Methods: the clinical data of 29 patients with severe POP who were treated by the same doctor in the second Hospital of Hebei Medical University from November 2008 to February 2014 were analyzed retrospectively. The pelvic tube prolapse quantitative staging method was used to classify the patients with POP. Pelvic floordistress inventory-short form20PFDI-20) and pelvic floor disease quality of life (PFIQ-7) were used to evaluate patients' symptoms and health-related quality of life (HRQLL), and POP/ urinary incontinence was used to ask about sexual life. Volume pelvic organ prolapse-urinary incontinence sexualquestionnaire PISQ-12) assess the patient's sexual quality. All patients were followed up for 1 month, 6 months, 12 months and every year. The results of follow-up were compared with preoperative data to evaluate the curative effect of LSC. At the same time, the operation time, intraoperative bleeding and hospital expenses were observed to evaluate the operation safety and economic burden. Results: the average operative time was 228.1 鹵35.2min / 130 ~ 280min, the average blood loss during operation was 120.0 鹵76.0ml / 50ml / 400ml / L, and the temperature was over 38.5 鈩

本文編號(hào)：1955183