摘要
目的探讨改良曼氏手术治疗重度盆腔器官脱垂伴宫颈延长的疗效及对患者生活质量的影响。方法选择2012年1月至2013年4月Ⅲ-Ⅳ期盆腔器官脱垂92例患者,其中50例伴宫颈延长患者行改良曼氏手术作为改良曼氏组,42例行植入网片的盆底重建术作为植入网片组。比较两组患者的手术时间、术中出血量、尿管保留时间、术后住院时间、总住院时间及总住院费用;术后1、6、12个月进行随访,填写盆底功能障碍问卷简表20（PFDI-20）、盆底功能影响问卷简表7（PFIQ-7）及盆底器官脱垂/尿失禁性生活影响问卷（PISQ-12）,评估手术对患者生活质量和性生活质量的影响。结果改良曼氏组与植入网片组的手术时间[（86.3±19.0）min,（83.7±20.3）min]、出血量[（82.9±80.6）ml,（67.0±52.1）ml]比较,差异无统计学意义（P〉0.05）。两组保留尿管时间[（4.4±1.6）d,（3.5±1.1）d）]、术后恢复时间[（7.7±2.2）d,（6.3±1.6）d]、总住院时间[（12.5±2.4）d,（9.7±2.7）d]、住院费用[（22 919.5±6 413.3）元,（6 513.5±2 329.3）元]比较,差异均有统计学意义（P均〈0.01）。植入网片组术前和术后12个月PFDI-20评分分别为（80.6±57.9）分和（30.2±73.8）分;PFIQ-7分别为（84.4±45.5）分和（27.8±33.4）分;改良曼氏组术前和术后12个月PFDI-20评分分别为（74.0±66.0）分和（10.0±23.0）分;PFIQ-7评分分别为（68.5±45.8）分和（18.3±30.3）分,两组术前、术后比较,差异均无统计学意义（P〉0.05）。植入网片组尿潴留2例,网片暴露1例;改良曼氏组尿潴留1例,两组患者均无复发。结论改良曼氏手术是治疗伴宫颈延长重度POP有效、安全、微创的手术之一,可以明显改善患者的生命质量,与植入网片盆底重建术疗效相当。
Objective To investigate the clinical efficiency and quality-of-life in severe pelvic organ prolapse（POP）women with prolonged cervix after improved-Manchester surgery.Methods 92 POP patients inⅢ-Ⅳstages who underwent surgery from January 2012 to April 2013 in Beijing Obstetrics Gynecology Affiliated to Capital Medical University enrolled this study.50 patients with prolonged cervix received Manchester surgery and other42 underwent transvaginal pelvic reconstructive surgery with synthetic mesh.The effect of surgery and quality of life was evaluated by clinical data and questionnaires including pelvic floor impact questionnaire-short form 7（PFIQ-7）,pelvic floor distress inventory-short form 20（PFDI-20）and pelvic organ prolapsed-urinary incontinence sexual questionnaire（PISQ）.Results There was no significant difference in operative time and blood loss in the two groups（P〉0.05）.The indwelling catheter time,the hospitalized time and the expenses was significant difference in the two groups（P〈0.01）.On one year follow-up,the scores of PFIQ-7and PFDI-20 in the two groups were significant lower than preoperative（P〈0.01）,but there was no significant difference before and after surgery between the two groups（P〉0.05）.Conclusion This study suggests that improved-Manchester surgery is safe and efficacy for the treatment of severe POP women with prolonged cervix.It could improve quality of life remarkably compared with pelvic floor reconstruction surgery with mesh.
出处
《中国妇产科临床杂志》
CSCD
北大核心
2015年第2期100-104,共5页
Chinese Journal of Clinical Obstetrics and Gynecology
基金
北京市科学技术委员会首都市民健康项目培育(Z111107067311024)
关键词
盆腔器官脱垂
改良曼氏手术
宫颈延长
网片
盆底重建术
生活质量
pelvic organ prolapse
improved-Manchester operation
prolonged cervix
mesh
pelvic floor reconstruction surgery
quality of life
