【摘要】：目的探討改良曼氏手術(shù)治療重度盆腔器官脫垂伴宮頸延長(zhǎng)的療效及對(duì)患者生活質(zhì)量的影響。方法選擇2012年1月至2013年4月Ⅲ~Ⅳ期盆腔器官脫垂92例患者,其中50例伴宮頸延長(zhǎng)患者行改良曼氏手術(shù)作為改良曼氏組,42例行植入網(wǎng)片的盆底重建術(shù)作為植入網(wǎng)片組。比較兩組患者的手術(shù)時(shí)間、術(shù)中出血量、尿管保留時(shí)間、術(shù)后住院時(shí)間、總住院時(shí)間及總住院費(fèi)用;術(shù)后1、6、12個(gè)月進(jìn)行隨訪,填寫盆底功能障礙問卷簡(jiǎn)表20(PFDI-20)、盆底功能影響問卷簡(jiǎn)表7(PFIQ-7)及盆底器官脫垂/尿失禁性生活影響問卷(PISQ-12),評(píng)估手術(shù)對(duì)患者生活質(zhì)量和性生活質(zhì)量的影響。結(jié)果改良曼氏組與植入網(wǎng)片組的手術(shù)時(shí)間[(86.3±19.0)min,(83.7±20.3)min]、出血量[(82.9±80.6)ml,(67.0±52.1)ml]比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組保留尿管時(shí)間[(4.4±1.6)d,(3.5±1.1)d)]、術(shù)后恢復(fù)時(shí)間[(7.7±2.2)d,(6.3±1.6)d]、總住院時(shí)間[(12.5±2.4)d,(9.7±2.7)d]、住院費(fèi)用[(22 919.5±6 413.3)元,(6 513.5±2 329.3)元]比較,差異均有統(tǒng)計(jì)學(xué)意義(P均0.01)。植入網(wǎng)片組術(shù)前和術(shù)后12個(gè)月PFDI-20評(píng)分分別為(80.6±57.9)分和(30.2±73.8)分;PFIQ-7分別為(84.4±45.5)分和(27.8±33.4)分;改良曼氏組術(shù)前和術(shù)后12個(gè)月PFDI-20評(píng)分分別為(74.0±66.0)分和(10.0±23.0)分;PFIQ-7評(píng)分分別為(68.5±45.8)分和(18.3±30.3)分,兩組術(shù)前、術(shù)后比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。植入網(wǎng)片組尿潴留2例,網(wǎng)片暴露1例;改良曼氏組尿潴留1例,兩組患者均無復(fù)發(fā)。結(jié)論改良曼氏手術(shù)是治療伴宮頸延長(zhǎng)重度POP有效、安全、微創(chuàng)的手術(shù)之一,可以明顯改善患者的生命質(zhì)量,與植入網(wǎng)片盆底重建術(shù)療效相當(dāng)。
[Abstract]:Objective to investigate the effect of modified Mann's operation on severe pelvic organ prolapse with cervical extension and its effect on quality of life (QOL). Methods from January 2012 to April 2013, 92 patients with pelvic organ prolapse were selected. Among them, 50 patients with cervical extension underwent modified Mann's operation and 42 patients underwent pelvic floor reconstruction with mesh implantation. The operation time, intraoperative bleeding volume, retention time of urinary catheter, postoperative hospitalization time, total hospitalization time and total hospitalization cost were compared between the two groups. The patients were followed up at 1: 6 and 12 months after operation. The pelvic floor dysfunction questionnaire (PFDI-20), pelvic floor function impact questionnaire (PFIQ-7) and pelvic floor prolapse / urinary incontinence (PISQ-12) were completed. To evaluate the effect of surgery on patients' quality of life and sexual life. Results there was no significant difference in operative time (86.3 鹵19.0) min, (, 83.7 鹵20.3 min) and blood loss (82.9 鹵80.6) ml, (, 67.0 鹵52.1) ml) between the modified Mann group and the mesh implantation group (P0.05). The duration of retention of urinary catheter [(4.4 鹵1.6) d, () 3.5 鹵1.1) d)], postoperative recovery time [(7.7 鹵2.2) d, (6.3 鹵1.6) days], total hospitalization time [(12.5 鹵2.4) days] in both groups. The cost of hospitalization [(22 919.5 鹵6 413.3) yuan, (6 513.5 鹵2 329.3) yuan] was significantly different (P < 0. 01). The PFDI-20 scores were (80.6 鹵57.9) and (30.2 鹵73.8), the PFIQ-7 scores were (84.4 鹵45.5) and (27.8 鹵33.4) in the mesh implantation group. The PFDI-20 scores before and 12 months after operation were (74.0 鹵66.0) and (10.0 鹵23.0) in modified Mann's group. The PFIQ-7 scores were (68.5 鹵45.8) and (18.3 鹵30.3), respectively. There was no significant difference between the two groups before and after operation (P0.05). There were 2 cases of urinary retention and 1 case of net exposure in the implanted mesh group, and 1 case in the modified Mann group. No recurrence was found in both groups. Conclusion modified Mann's operation is one of the effective, safe and minimally invasive procedures for the treatment of severe POP with cervical extension. It can significantly improve the quality of life of the patients and is comparable to the effect of pelvic floor reconstruction.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京婦產(chǎn)醫(yī)院;
【基金】：北京市科學(xué)技術(shù)委員會(huì)首都市民健康項(xiàng)目培育(Z111107067311024)
【分類號(hào)】：R713

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