腹腔镜辅助经阴道子宫全切除术联合多术式治疗中重度盆腔器官脱垂的临床分析

沈逸++李学华

[摘要] 目的 探討腹腔镜辅助经阴道子宫全切除术联合多术式治疗中重度盆腔器官脱垂（pelvic organ prolapse，POP）性疾病的疗效、安全性及并发症。 方法 回顾性分析海宁市人民医院2009年5月～2012年12月收治的55例POP患者的临床资料，其中腹腔镜辅助经阴道子宫全切除术联合多术式治疗组26例、传统手术组29例。观察手术时间、术中出血量，术后并发症等情况，并定期随访和评价术后疗效。 结果 两组治愈率均为100%，尽管腹腔镜组手术时间比传统手术组平均长24 min，但腹腔镜组的术中出血量只有传统手术组的一半，住院时间也缩短了1.5 d，且两组在手术时间、住院天数及术中出血量3个方面比较，差异均有统计学意义。 结论 腹腔镜辅助经阴道子宫切除术联合多术式的手术方式在治疗中重度盆腔器官脱垂中应用有效，是传统经阴道子宫全切除术的一种补充。它可以扩大经阴道手术的适应人群，并且是安全可行的手术方式。

[关键词] 腹腔镜手术；经阴道手术；盆腔器官脱垂；子宫全切除术；多术式

[中图分类号] R713 [文献标识码] B [文章编号] 1673-9701（2017）04-0058-04

Clinical analysis of laparoscopy-assisted transvaginal hysterectomy combined with multiple procedures in the treatment of moderate and severe pelvic organ prolapse

SHEN Yi LI Xuehua

Department of Gynecology and Obstetrics， Zhejiang Haining People's Hospital， Shanghai Changhai Hospital Haining Branch， Haining 314400， China

[Abstract] Objective To investigate the efficacy， safety and complications of laparoscopy-assisted transvaginal hysterectomy combined with multiple procedures in the treatment of moderate and severe pelvic organ prolapse （POP）. Methods Clinical data of 55 patients with POP who were admitted to Haining People's Hospital from May 2009 to December 2012 were retrospectively analyzed. 26 patients were assigned to the treatment group receiving laparoscopy-assisted transvaginal hysterectomy combined with multiple procedures， and 29 patients were assigned to the traditional surgery group. The operation time， intraoperative bleeding and postoperative complications were observed， and regular follow-up and postoperative curative effects were evaluated. Results The two groups were 100% cured. Although the operation time in the laparoscopy group was 24 minutes in average longer than that in the traditional surgery group， but in general the intraoperative blood loss in the laparoscopy group was only half of that in the traditional surgery group. The length of stay was also shortened by 1.5 days. There were significant differences in operation time， length of stay and intraoperative bleeding between the two groups. Conclusion Laparoscopy-assisted transvaginal hysterectomy combined with multiple procedures is effective in the treatment of moderate and severe pelvic organ prolapse. It is a supplement to traditional transvaginal hysterectomy. It can extend the population applicable to transvaginal surgery， and is a safe and feasible surgical procedure.

[Key words] Laparoscopic surgery； Transvaginal surgery； Pelvic organ prolapse； Total hysterectomy； Multiple procedures

中国老年女性盆底功能障碍性疾病（PFD）的发生率为20%～40%，主要是盆腔器官脱垂（pelvic organ prolapse，POP）性疾病。POP手术早已不再只是传统的经阴道手术，随着盆底重建理论的提出，POP手术方式有了一个革命性的发展[1-3]。POP手术如何安全、高效、微创一直是临床探讨的核心问题。本文针对在腹腔镜辅助下经阴道子宫全切除术联合多术式对中重度POP进行治疗并已完成1年以上随访的病例进行了回顾性分析。……