摘要
目的 分析经阴道自然腔道内镜手术(V-NOTES)下自体组织重建对盆腔器官脱垂(POP)患者的有效性及安全性。方法 选取2022年9月至2024年9月我院行V-NOTES下自体组织重建的136例POP患者为研究对象,术后1年根据盆腔器官脱垂定量分期法(POP-Q)将患者分为客观治愈组(n=122)和未治愈或复发组(n=14)。多因素Logistic回归分析治疗结局影响因素及并发症危险因素。结果 根据POP-Q评分,治疗后,0度患者108例(79.41%),Ⅰ度患者14例(10.29%),Ⅱ度患者9例(6.62%),Ⅲ度患者5例(3.38%),术后客观治愈率为89.71%。并发症共发生30例(22.06%)。术前高C反应蛋白(CRP)水平(OR=1.587,95%CI:1.369~1.785,P<0.001)、术前高白细胞(WBC)水平(OR=2.657,95%CI:1.695~5.269,P<0.001)、术前PA低水平(OR=0.589,95%CI:0.327~0.853,P<0.001)是POP治疗后未治愈或复发的独立危险因素。患者全子宫切除术既往手术史(OR=1.256,95%CI:1.128~3.187,P<0.001)、子宫肌瘤剔除术既往手术史(OR=2.654,95%CI:1.659~4.558,P<0.001)、术前CRP水平较高(OR=3.118,95%CI:2.147~5.436,P<0.001)是并发症风险的独立危险因素。结论 V-NOTES自体组织修复作为一种新兴的治疗策略,在治疗POP方面显示出较高的安全性和有效性,术前控制炎症反应和保持良好营养状态对治疗效果具有积极作用。
Objective To analyze the effectiveness and safety of autologous tissue reconstruction via vaginal natural orifice transluminal endoscopic surgery(V-NOTES)in patients with pelvic organ prolapse(POP).Methods A total of 136 POP patients who had V-NOTES autologous tissue repair performed at our facility between September 2022 and September 2024 were enrolled into the research subjects.According to the pelvic organ prolapse quantitative staging method(POP-Q),the patients were split into two groups one year following surgery:an objective cure group(n=122)and a non-cure or recurrence group(n=14).Multivariate logistic regression was used to analyze the determinants of treatment outcome and risk variables for complications.Results According to POP-Q score,after treatment,108 patients(79.41%)were at grade 0,14 patients(10.29%)at grade I,9 patients(6.62%)at grade II,and 5 patients(3.38%)at grade III.The objective cure rate after the operation was 89.71%.Complications occurred in 30 cases(22.06%).Preoperative high C-reactive protein(CRP)level(OR=1.587,95%CI:1.369-1.785,P<0.001),preoperative high white blood cell(WBC)level(OR=2.657,95%CI:1.695-5.269,P<0.001),and preoperative low PA level(OR=0.589,95%CI:0.327-0.853,P<0.001)were independent risk factors for non-cure or recurrence after POP treatment.The patient's previous surgical history of total hysterectomy(OR=1.256,95%CI:1.128-3.187,P<0.001)and previous surgical history of myomectomy(OR=2.654,95%CI:1.659-4.558,P<0.001)and a higher preoperative CRP level(OR=3.118,95%CI:2.147-5.436,P<0.001)were independent risk factors for complications.Conclusions V-NOTES autologous tissue repair,as an emerging treatment strategy,showed high safety and effectiveness in the treatment of POP.Controlling the inflammatory response and maintaining a good nutritional status before the operation had a positive effect on the treatment outcome.
作者
管海凤
鲍二臣
于楠
Guan Haifeng;Bao Erchen;Yu Nan(Department of Gynecology and Obstetrics,Xinyi People's Hospital,Xinyi 221400,Jiangsu Province,China;Department of Gynecology,Xinyi People's Hospital,Xinyi 221400,Jiangsu Province,China)
出处
《中国临床解剖学杂志》
北大核心
2026年第1期96-103,共8页
Chinese Journal of Clinical Anatomy
基金
徐州市科技局项目2023年度医药卫生面上项目(KC23349)。
关键词
盆腔器官脱垂
经阴道自然腔道内镜手术
自体组织重建
有效性
Pelvic organ prolapse
Vaginal natural orifice transluminal endoscopic surgery
Autologous tissue reconstruction
Effectiveness
