【摘要】：目的： 分析比較傳統(tǒng)術(shù)式與盆底重建術(shù)治療盆腔臟器脫垂（POP）的療效。 方法： 選擇2010年1月至2014年1月期間因POP而手術(shù)治療的患者139例為研究對(duì)象。分為無(wú)補(bǔ)片組77例（包括曼氏手術(shù)35例、經(jīng)陰子宮切除術(shù)+陰道前后壁修補(bǔ)術(shù)42例）和補(bǔ)片組62例（包括Prolift補(bǔ)片25例、Avaulta補(bǔ)片22例、Prosima補(bǔ)片15例）兩組。比較兩組患者手術(shù)時(shí)間、術(shù)中出血量、手術(shù)費(fèi)用、住院天數(shù)，作為手術(shù)一般情況的分析；術(shù)前及術(shù)后復(fù)診時(shí)POP-Q評(píng)分的變化作為客觀療效的分析。電話結(jié)合電子郵件的方式隨訪，無(wú)補(bǔ)片組平均隨訪時(shí)間為術(shù)后（25.00±14.29）月，而補(bǔ)片組平均隨訪時(shí)間為術(shù)后（24.35±10.78）月。兩組隨訪時(shí)間差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。比較兩組患者術(shù)前及隨訪時(shí)盆底障礙量表簡(jiǎn)表（PFDI-20）、盆底影響問(wèn)卷簡(jiǎn)表(PFIQ-7)的相關(guān)評(píng)分，，作為患者主觀療效及生活質(zhì)量影響程度的評(píng)價(jià)。 結(jié)果： （1）補(bǔ)片組手術(shù)時(shí)間（62.47±27.83）min少于無(wú)補(bǔ)片組（87.40±25.66）min，差異有統(tǒng)計(jì)學(xué)意義(P0.01)；補(bǔ)片組術(shù)中出血量（37.98±16.16）ml少于無(wú)補(bǔ)片組（57.27±35.16） ml，差異有統(tǒng)計(jì)學(xué)意義(P0.01)；無(wú)補(bǔ)片組手術(shù)費(fèi)用（11794.77±2990.38）元低于補(bǔ)片組（19425.23±7596.38）元，差異有統(tǒng)計(jì)學(xué)意義（P0.01）。 （2）術(shù)前兩組患者POP-Q分度差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。兩組患者復(fù)診率分別為：補(bǔ)片組98.39%和無(wú)補(bǔ)片組93.51%。術(shù)后兩組患者POP-Q分度差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05），患者術(shù)前與術(shù)后復(fù)診時(shí)POP-Q分度差異明顯，有統(tǒng)計(jì)學(xué)意義（P0.01）。 （3）隨訪時(shí)，補(bǔ)片組PFDI-20評(píng)分由術(shù)前的（69.72±19.04）分降為（11.36±6.10）分，PFIQ-7評(píng)分由（75.90±19.19）分降為（14.75±6.83）分；無(wú)補(bǔ)片組PFDI-20評(píng)分由術(shù)前的（67.79±17.88）分降為（17.84±6.22）分，PFIQ-7評(píng)分由（75.55±17.85）分降為（23.66±11.85）分。兩組患者隨訪時(shí)的PFDI-20、PFIQ-7及其分量表評(píng)分較術(shù)前明顯下降，差異有統(tǒng)計(jì)學(xué)意義（P0.01）。無(wú)補(bǔ)片組隨訪時(shí)PFDI-20及其分量表、PFIQ-7、POPIQ-7、UIQ-7評(píng)分高于補(bǔ)片組，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；CRAIQ-7評(píng)分高于補(bǔ)片組，但差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論： 傳統(tǒng)手術(shù)及補(bǔ)片盆底重建術(shù)是POP的有效治療方式，兩者近期解剖學(xué)復(fù)位療效相仿，但補(bǔ)片盆底重建術(shù)擁有更好的遠(yuǎn)期主觀療效。補(bǔ)片盆底重建術(shù)價(jià)格較高，要求患者有一定的經(jīng)濟(jì)基礎(chǔ)。
[Abstract]:Objective: to compare the efficacy of traditional operation and pelvic floor reconstruction in the treatment of pelvic organ prolapse (POP). Methods: 139 patients with POP from January 2010 to January 2014 were selected. 77 cases (including 35 cases of Mann's operation, 42 cases of transvaginal hysterectomy) and 62 cases of patch group (including 25 cases of Prolift patch and 22 cases of Prosima patch) were divided into two groups. The time of operation, the amount of blood lost during operation, the cost of operation and the days of hospitalization were compared between the two groups. The changes of POP-Q score before and after operation were analyzed as objective curative effect. The average follow-up time was (25.00 鹵14.29) months in the non-patch group and (24.35 鹵10.78) months in the patch group. There was no significant difference in follow-up time between the two groups (P0.05). The correlation scores of pelvic floor disorder scale (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7) were compared between the two groups as the evaluation of subjective curative effect and quality of life (QOL). Results: (1) the operative time was (62.47 鹵27.83) min in the patch group and (87.40 鹵25.66) minutes in the non-patch group, the difference was statistically significant (P0.01), and the intraoperative bleeding volume in the patch group was (37.98 鹵16.16) ml lower than that in the non-supplement group (57.27 鹵35.16) ml (P0.01). The cost of operation in the non-supplement group (11794.77 鹵2990.38) yuan was lower than that in the supplement group (19425.23 鹵7596.38) yuan, the difference was statistically significant (P0.01). (2). There was no significant difference in the POP-Q score between the two groups before operation (P0.05). The follow-up rate of the two groups was 98.39% in the patch group and 93.51% in the control group. There was no significant difference in POP-Q score between the two groups after operation (P0.05). There was a significant difference in POP-Q score between the patients before and after follow-up (P0.01). (3). The PFDI-20 score of the supplement group was decreased from (69.72 鹵19.04) to (11.36 鹵6.10) and that of the non-supplement group from (75.90 鹵19.19) to (14.75 鹵6.83), from (67.79 鹵17.88) to (17.84 鹵6.22), from (75.55 鹵17.85) to (23.66 鹵11.85). The PFDI-20 PFIQ-7 and its subscale scores in the two groups were significantly lower than those before operation (P0.01). The scores of PFDI-20 and its components in the follow-up group were higher than those in the supplement group (P0.05), but the difference was not statistically significant (P0.05). Conclusion: traditional surgery and pelvic floor reconstruction are effective methods for POP. The effect of anatomical reduction is similar in the near future, but the reconstruction of pelvic floor repair has better long-term subjective effect. The price of pelvic floor reconstruction is high, requiring patients to have a certain economic base.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R713

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