本文選題：骶主韌帶-陰道環(huán)重建術 + I期盆腔器官脫垂��； 參考：《寧夏醫(yī)科大學》2014年碩士論文

【摘要】：第一部分 骶主韌帶-陰道環(huán)重建術在治療I期盆腔器官脫垂中的臨床應用 目的探討骶主韌帶-陰道環(huán)重建術在治療I期盆腔器官脫垂中的療效，并探討其對患者術后生活質量的影響。 方法選取患有子宮良性病變且合并I期盆腔器官脫垂患者60例，根據(jù)患者術前知情同意情況其中30例行經(jīng)腹全子宮切除術+骶主韌帶-陰道環(huán)重建術（A懸吊組），另30例行單純經(jīng)腹子宮全切術（A對照組），術前、術后1月、3月、6月根據(jù)POP-Q分度、陰道長度等指標判斷療效、生活質量問卷（PFID--20)評估患者生活質量。（本研究已通過倫理學標準，并與患者簽署同意書） 結果A懸吊組與A對照組在疾病分布、年齡、產(chǎn)次、術前POP-Q分度、術前PFID--20評分及平均手術時間、術中出血量等方面無明顯差異（P0.05）；A懸吊組與A對照組在疾病分布、年齡、產(chǎn)次、術前POP-Q分度、術前PFID--20評分及平均手術時間、術中出血量等方面無明顯差異（P0.05）；術后1月、3月、6月A懸吊組C點測量值分別為-8.13±0.68、-8.11±0.75、-8.18±0.68，A對照組C點測量值分別為-7.15±1.27、-6.90±1.27、-6.81±1.24，兩組比較差異顯著（P0.05）；術后1月、3月、6月懸吊組Aa點測量值分別為-2.51±0.49、-2.41±0.49、-2.46±0.49，對照組分別為-1.97±0.97、-1.95±0.15、-1.98±0.15，兩組比較有顯著差異（P0.05）；術后1月、3月、6月A懸吊組Ba點測量值分別為-2.90±0.30、-2.86±0.34、-2.88±0.31,A對照組分別為-2.50±0.41、-2.41±0.43、-2.43±0.44，兩組比較有顯著差異（P0.05）；術后1月、3月、6月A懸吊組Ap點測量值分別為-2.40±0.57、-2.36±0.57、-2.46±0.58，A對照組分別為-1.81±0.30、-1.83±0.30、-1.86±0.36，兩組比較有顯著差異（P0.05）；術后1月、3月、6月A懸吊組Bp點測量值分別為-2.86±0.31、-2.90±0.27、-2.86±0.29，A對照組分別為-2.36±1.01、-2.35±1.00、-2.30±1.01，兩組比較有顯著差異（P0.05）；生活質量問卷評分A懸吊組術后1月、3月、6月分別為35.57±9.87、33.63±9.66、32.23±9.42，A對照組分別為43.37±5.82、43.20±5.85、44.73±6.14，兩組比較有顯著差異（P0.05）。 結論骶主韌帶-陰道環(huán)重建術可重建陰道環(huán)代替宮頸環(huán)的盆底支持作用，治療I期盆腔器官脫垂，改善患者術后生活質量，臨床療效肯定，副作用少。 第二部分 骶主韌帶-陰道環(huán)重建術在預防子宮全切術后盆腔器官脫垂中的臨床應用 目的探討骶主韌帶-陰道環(huán)重建術在預防子宮全切術后盆腔器官脫垂中的可行性及其對患者術后生活質量的影響。 方法選取患有子宮良性病變且排除盆腔器官脫垂患者50例，根據(jù)患者術前知情同意情況取其中20例行經(jīng)腹全子宮切除術+骶主韌帶-陰道環(huán)重建術（B懸吊組）；另30例行單純經(jīng)腹子宮全切術（B對照組），術前、術后1月、3月、6月根據(jù)POP-Q分度、陰道長度等指標判斷療效、生活質量問卷（PFID--20)評估患者生活質量。（本研究已通過倫理學標準，并與患者簽署同意書） 結果B懸吊組與B對照組在疾病分布、年齡、產(chǎn)次、術前POP-Q分度、術前PFID--20評分及平均手術時間、術中出血量等方面無明顯差異（P0.05）；術后1月、3月、6月B懸吊組Aa點測量值分別為-3.00±0.00、-2.82±0.37、-2.70±0.47，，B對照組分別為-2.96±0.18、-2.86±0.34、-2.76±0.43，兩組相比較，差異無統(tǒng)計學意義（P0.05）。術后1月、3月、6月B懸吊組Ba點測量值分別為-3.00±0.00、-2.97±0.11、-2.87±0.31，B對照組分別為-2.98±0.09、-3.00±0.00、-2.90±0.30，兩組同期相比較，無明顯差異（P0.05）；術后1月、3月、6月B懸吊組Ap點測量值分別為-3.00±0.00、-3.00±0.00、-2.80±0.41，B對照組分別為-3.00±0.00、-2.86±0.31、-2.55±0.49，兩組同期相比較，術后3月及6月B懸吊組均高于B對照組，差異顯著（P0.01）；術后1月、3月、6月B懸吊組Bp點測量值分別為-3.00±0.00、-3.00±0.00、-2.95±0.22，B對照組分別為-3.00±0.00、-2.98±0.09、-2.81±0.36，兩組同期相比較，術后6月B懸吊組均高于B對照組，差異顯著（P0.01），而術后1月及3月無顯著差異（P0.05）。術后1月、3月、6月B懸吊組C點測量值分別為-8.75±0.41、-8.82±0.37、-8.20±0.65，B對照組C點測量值分別為-7.98±0.72、-7.20±2.74、-6.50±0.97，同一月份比較，兩組無顯著差異（P0.05）。生活質量問卷評分B懸吊組術后1月、3月、6月分別為37.95±8.38、39.95±6.37、39.25±8.22，B對照組分別為42.30±4.97、44.77±6.27、46.67±6.68，兩組同期相比較，術后1月B懸吊組明顯低于B對照組有顯著差異（P0.05），術后3月、6月兩組相比較無明顯差異（P0.05） 結論骶主韌帶-陰道環(huán)重建術可重建陰道環(huán)代替宮頸環(huán)的盆底支持作用，能夠一定程度上預防子宮全切術后盆腔器官脫垂的發(fā)生，尤其對于陰道后壁脫垂及穹窿脫垂療效肯定，但需延長隨訪時間觀察其確切療效。
[Abstract]:Part one
Clinical application of sacral main ligament vaginal ring reconstruction in the treatment of pelvic organ prolapse in stage I
Objective to explore the effect of sacral main ligament vaginal ring reconstruction in the treatment of pelvic organ prolapse in stage I, and to explore its effect on postoperative quality of life.
Methods 60 patients with benign uterine lesions and I stage pelvic organ prolapse were selected. According to the preoperative informed consent of the patients, 30 cases were treated by abdominal total hysterectomy plus sacral ligaments vaginal ring reconstruction (A suspension group), and the other 30 cases with simple abdominal hysterectomy (A control group), preoperative, January, March, June, according to the POP-Q degree, Yin. The quality of life questionnaire (PFID--20) was used to assess the quality of life of patients.
Results there was no significant difference between A suspension group and A control group in disease distribution, age, birth time, preoperative POP-Q score, preoperative PFID--20 score and average operation time, bleeding amount in operation (P0.05), A suspension group and A control group in disease distribution, age, birth time, preoperative POP-Q degree, preoperative PFID--20 score and mean operation time, intraoperative bleeding, etc. There was no significant difference (P0.05). The measurement values of C points in the A suspension group in January, March and June were -8.13 + 0.68, -8.11 0.75 and -8.18 0.68 respectively. The C points measured in the A control group were -7.15 + 1.27, -6.90 + 1.27 and -6.81 1.24 respectively. The two groups were significantly different (P0.05), and January, March and June respectively. .46 + 0.49, the control group was -1.97 0.97, -1.95 + 0.15, -1.98 + 0.15, and the two groups had significant differences (P0.05). The measurements of Ba points in the A suspension group in January, March, and June were -2.90 + 0.30, -2.86 + 0.34, -2.88 + 0.31 respectively, A control group were -2.50 0.41, 0.43 and 0.44, two groups were significantly different, January, March, 6. The measured values of Ap points in the A suspension group were -2.40 + 0.57, -2.36 + 0.57 and -2.46 0.58, A control group were -1.81 + 0.30, -1.83 + 0.30 and -1.86 + 0.36 respectively. The two groups were significantly different (P0.05). In January, March, June A suspension group were 0.36, 0.27 and 0.29, respectively. The difference between the two groups was 30 + 1.01 (P0.05), and the quality of life questionnaire (qqq) was 35.57 + 9.87,33.63 + 9.66,32.23 + 9.42 after the operation in January, March and June respectively, and the A control group was 43.37 + 5.82,43.20 + 5.85,44.73 + 6.14 respectively. There were significant differences in the two groups (P0.05).
Conclusion the reconstruction of the main sacral ligament and vagina ring can reconstruct the pelvic floor support of the vaginal ring instead of the cervix ring, and treat the I stage pelvic organ prolapse and improve the postoperative life quality of the patients. The clinical effect is positive and the side effects are few.
The second part
Clinical application of sacral main ligament vaginal ring reconstruction in preventing pelvic organ prolapse after total hysterectomy
Objective to explore the feasibility of sacral main ligament vaginal ring reconstruction in preventing pelvic organ prolapse after total hysterectomy and its effect on postoperative quality of life.
Methods 50 patients with benign lesions of the uterus were selected to exclude pelvic organ prolapse. According to the preoperative informed consent of the patients, 20 cases were treated by abdominal total hysterectomy plus sacral ligamentum vagina reconstruction (B suspension group), and the other 30 cases with simple Transabdominal Total resection (B control group), preoperative, January, March, June, according to the POP-Q degree and Yin. The quality of life questionnaire (PFID--20) was used to assess the quality of life of patients.
Results there was no significant difference between B suspension group and B control group in disease distribution, age, birth time, preoperative POP-Q score, preoperative PFID--20 score, average operation time, and intraoperative bleeding volume (P0.05). In January, March, and June B suspension group, Aa points were -3.00 + 0, -2.82 + 0.37, -2.70 + 0.47, B control group were -2.96 0.18 and 0.34 -2.76 + 0.43, two groups compared, the difference was not statistically significant (P0.05). In January, March, June B suspension group Ba point measurements were -3.00 0, -2.97 + 0.11, -2.87 + 0.31, B control groups were -2.98 + 0.09, -3.00 + 0, -2.90 + 0.30, two groups compared, no significant difference (P0.05); January, March, June, suspension group -3.00 + 0, -3.00 + 0, -2.80 + 0.41, B control group were -3.00 0, -2.86 0.31, -2.55 + 0.49, two groups were compared in the same period, the B suspension group in March and June were higher than the B control group, the difference was significant (P0.01); the Bp points of January, March, June B suspension group were respectively 0.49, 0 and 0.22, respectively. 00 + 0, -2.98 + 0.09, -2.81 + 0.36, two groups compared with the same period, in June, the B suspension group was higher than the B control group, the difference was significant (P0.01), but there was no significant difference between January and March (P0.05). The measurement values of C points in B suspension group in January, March and June were -8.75 + 0.41, -8.82 + 0.37, -8.20 + 0.65 respectively. The measurement values of B control group were 0.41, 0.72 and 2., respectively. 74, -6.50 + 0.97, compared with January, there was no significant difference between the two groups (P0.05). The quality of life questionnaire score of the B suspension group was 37.95 + 8.38,39.95 + 6.37,39.25 + 8.22 in June, March and June respectively. The B control group was 42.30 + 4.97,44.77 + 6.27,46.67 + 6.68 respectively. Compared with those in the same period of the two groups, the January B suspension group was significantly lower than the B control group (P0). .05), there was no significant difference between the two groups in March and June after operation (P0.05).
Conclusion the reconstruction of the main ligaments of the sacral ligament and vagina ring can reconstruct the pelvic floor support of the vaginal ring instead of the cervix. It can prevent the occurrence of pelvic organ prolapse to a certain extent, especially for the posterior vaginal wall prolapse and fornix prolapse, but it is necessary to prolong the follow-up time to observe the exact effect.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R713

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相關期刊論文 前1條

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