【摘要】：研究目的：比較陰式子宮全切除術+陰道前后壁修補術和Surgimesh盆底重建術在治療女性盆底功能障礙中的臨床療效及對患者術后生活質量的影響。 資料與方法：收集2009年11月-2012年01月青海大學附屬醫(yī)院婦科93例診斷為女性盆底功能障礙的患者，根據(jù)手術方式不同，分為研究組和對照組，研究組為Surgimesh盆底重建術患者51例，對照組為陰式子宮全切除術+陰道前后壁修補術患者42例，兩組患者的年齡、體重指數(shù)、孕次、產(chǎn)次等一般臨床資料無統(tǒng)計學差異（P0.05），對比兩組患者的治愈率評價手術效果，并對兩組患者術前、術后的盆底功能影響問卷（PFIQ-7）、盆底功能障礙問卷（PFDI-20）進行調查，評價其術后生活質量。 結果：1、研究組平均手術時間為108.3±29.4min，平均術中出血量為192.3±72.9ml，平均保留尿管時間為3.8±1.1d，平均術后住院時間為7.1±1.5d，對照組平均手術時間為127.0±18.5min，平均術中出血量為251.4±56.2ml，平均保留尿管時間為3.6±0.7d，平均術后住院時間為9.0±2.4d，比較兩組以上指標，在平均手術時間、平均術中出血量和平均術后住院時間上具有統(tǒng)計學差異（P0.05）；在平均保留尿管時間上沒有差異（P0.05）。2、手術療效研究組的隨訪率100%，對照組術后6個月、1年、2年的隨訪率分別為100%（42/42），95.24%（40/42），92.86%（39/42）。在術后6個月隨訪，研究組100%（51/51）治愈率高于對照組治愈率95.24%（40/42），但是沒有統(tǒng)計學差異（2=2.482，P=0.115）；術后1年和術后2年隨訪，研究組的治愈率均高于對照組，并且差異具有統(tǒng)計學意義（P0.05）。3、術后評分情況兩組患者術后PFIQ-7和PFDI-20評分較術前均有顯著性下降（P0.05）。但研究組術后6個月、1年和2年PFIQ-7、PFDI-20評分均低于同期對照組（P0.05）。 結論：1、Surgimesh盆底重建術臨床療效顯著，達到預期的效果，對提高患者的生活質量有較大幫助。2、Surgimesh盆底重建術的治愈率較陰式子宮全切除術+陰道前后壁修補術高，術后生活質量的改善更好，，但遠期療效仍需進一步隨訪。
[Abstract]:Objective: to compare the clinical effect of vaginal anterior and posterior wall repair and Surgimesh pelvic floor reconstruction in the treatment of female pelvic floor dysfunction. Materials and methods: from November 2009 to January 2012, 93 patients with pelvic floor dysfunction diagnosed by gynecology of affiliated Hospital of Qinghai University were divided into study group and control group according to the different operation methods. 51 patients with Surgimesh pelvic floor reconstruction were enrolled in the study group. The control group was 42 patients with vaginal wall repair after vaginal hysterectomy. There was no significant difference in age, body mass index, pregnancy, labor and other general clinical data between the two groups (P0.05). The curative rate of the two groups was compared to evaluate the effect of operation. The preoperative and postoperative pelvic floor impact questionnaire (PFIQ-7) and pelvic floor dysfunction questionnaire (PFDI-20) were investigated to evaluate the postoperative quality of life. Results: 1. The average operative time, mean intraoperative bleeding, retention time and hospitalization time were 108.3 鹵29.4 min, 192.3 鹵72.9 ml, 3.8 鹵1.1 d, 7.1 鹵1.5 d, 127.0 鹵18.5 min, 251.4 鹵56.2 ml, and mean catheter retention time, respectively, in the study group (108.3 鹵29.4 min), in the control group (127.0 鹵18.5 min), in the average intraoperative bleeding volume (251.4 鹵56.2 ml), and in the retention of urinary catheter. The mean hospitalization time was 9.0 鹵2.4 days and 3.6 鹵0.7 days. The above indexes were compared between the two groups. There were significant differences in average operative time, average intraoperative bleeding volume and average postoperative hospitalization time (P0.05). There was no difference in the mean retention time of urinary catheter (P0.05). The follow-up rate of the study group was 100%. The follow-up rates of the control group were 100% (42 / 42), 95.24% (40 / 42) and 92.86% (39 / 42) respectively at 6 months, 1 year and 2 years after operation. After 6 months follow-up, the cure rate in the study group was 100% (51 / 51) higher than that in the control group 95.24% (40 / 42), but there was no statistical difference (22.482P 0.115), and the cure rate in the study group was higher than that in the control group after 1 and 2 years follow-up. And the difference was statistically significant (P0.05). The postoperative scores of two groups of patients after PFIQ-7 and PFDI-20 scores were significantly lower than before (P0.05). However, the PFIQ-7,PFDI-20 scores in the study group at 6 months, 1 year and 2 years were lower than those in the control group (P0.05). Conclusion: (1) Surgimesh pelvic floor reconstruction has a significant clinical effect, achieves the desired effect, and is of great help to improve the quality of life of the patients. 2 Surgimesh pelvic floor reconstruction has a higher cure rate than that of vaginal wall repair after vaginal hysterectomy. The improvement of quality of life after operation is better, but the long-term effect still needs further follow-up.
【學位授予單位】：青海大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R713

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