本文選題：盆腔器官脫垂 + 經(jīng)陰道骶棘韌帶懸吊術(shù)��； 參考：《南昌大學(xué)》2015年碩士論文

【摘要】：目的:比較經(jīng)陰道骶棘韌帶懸吊術(shù)(VSSLF)、全盆底重建術(shù)、經(jīng)陰道全子宮切除+陰道前/后壁修補(bǔ)術(shù)三種術(shù)式對(duì)重度盆腔器官脫垂(POP)的臨床療效,探討VSSLF臨床應(yīng)用的價(jià)值。方法:選擇江西省人民醫(yī)院2009年1月-2011年12月因盆腔器官脫垂POP-Q評(píng)分為Ⅲ、Ⅳ期,要求手術(shù)治療的患者90例,分別采用VSSLF(A組,30例)、全盆底重建術(shù)(B組,30例)、經(jīng)陰道全子宮切除+陰道前/后壁修補(bǔ)術(shù)(C組,30例),分別對(duì)三組的術(shù)中情況(手術(shù)時(shí)間、出血量、術(shù)中并發(fā)癥),術(shù)后各項(xiàng)指標(biāo)(術(shù)后病率、住院時(shí)間、住院費(fèi)用、近期并發(fā)癥),術(shù)后隨訪(陰道長(zhǎng)度、各指示點(diǎn)POP-Q評(píng)分、遠(yuǎn)期并發(fā)癥、復(fù)發(fā)率、性生活滿意度及生活質(zhì)量)進(jìn)行對(duì)比。結(jié)果:A組的手術(shù)時(shí)間和術(shù)中出血量均少于B組和C組(P0.05);三組均未發(fā)生術(shù)中并發(fā)癥;三組的術(shù)后病率和住院時(shí)間等方面均無明顯差異(P0.05);A組的住院費(fèi)用與C組相近(P0.05),但低于B組(P0.05);A組術(shù)后3個(gè)月的陰道長(zhǎng)度大于B組和C組(P0.05);三組術(shù)后3個(gè)月Ba、Bp、C點(diǎn)的POP-Q評(píng)分均較術(shù)前有明顯改善(P0.05),其中A組C點(diǎn)位置高于B組和C組(P0.05);A組與B組的術(shù)后2年性生活滿意度及生活質(zhì)量相當(dāng)(P0.05),均高于C組(P0.05);A組術(shù)后2年的復(fù)發(fā)率與B組相當(dāng)(P0.05),但低于C組(P0.05)。結(jié)論:VSSLF:相對(duì)于經(jīng)陰道全子宮切除+陰道前/后壁修補(bǔ)術(shù),手術(shù)時(shí)間短,損傷小,出血少,性生活影響小,且可保留子宮;相對(duì)于全盆底重建術(shù),則費(fèi)用低,并發(fā)癥少。是一種微創(chuàng)、經(jīng)濟(jì)、安全、且不改變盆底解剖結(jié)構(gòu)及功能的術(shù)式,值得臨床推廣。
[Abstract]:Objective: to compare the clinical effects of VSS LFN, total pelvic floor reconstruction and transvaginal hysterectomy for severe pelvic organ prolapse (POP) by vaginal sacral ligamentum suspension (VSS LFN), total pelvic floor reconstruction (TPD) and transvaginal total hysterectomy (TTC) for the treatment of severe pelvic organ prolapse (POP), and to evaluate the clinical value of VSSLF in the treatment of severe pelvic organ prolapse. Methods: from January 2009 to December 2011, 90 patients with pelvic organ prolapse were selected from Jiangxi Provincial people's Hospital. VSS LFA group (n = 30), total pelvic floor reconstruction (group B) (n = 30) and vaginal hysterectomy with anterior / posterior wall repair (n = 30) were used respectively. Intraoperative complications, postoperative indicators (postoperative disease rate, hospital stay, hospitalization costs, short-term complications, postoperative follow-up (vaginal length, POP-Q score at each indication point, long-term complications, recurrence rate, etc.) Sexual satisfaction and quality of life) were compared. Results the operative time and intraoperative blood loss in group 1 were less than those in group B and group C (P 0.05), and no intraoperative complications were found in the three groups. There was no significant difference in postoperative morbidity and hospitalization time among the three groups. The hospitalization cost of group A was similar to that of group C, but lower than that of group B, the length of vagina 3 months after operation in group A was larger than that in group B and group C, and the POP-Q at point BaBpC of group A was higher than that of group B 3 months after operation. The scores in group A were higher than those in group B and group C, and the satisfaction and quality of life in group A and group B were similar to those in group B and group B, which were higher than those in group C and group B respectively. The recurrence rate of group A and group B was higher than that of group C and group B. The recurrence rate of group A was significantly higher than that of group A and group B, and the recurrence rate of group A was higher than that of group A and group B. When P0. 05, but lower than group C, P0. 05. Conclusion compared with the transvaginal total hysterectomy of anterior / posterior wall of vagina, the operation time is shorter, the injury is less, the bleeding is less, the sexual life is less, and the uterus can be preserved, compared with the whole pelvic floor reconstruction, the cost is low and the complications are less. It is a minimally invasive, economical, safe, and does not change the pelvic floor anatomical structure and function, worthy of clinical promotion.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R713

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本文編號(hào)：2049729