探讨腹腔镜下子宫腹直肌前鞘悬吊固定术治疗盆腔脏器脱垂(POP)的临床疗效。

选择2014年10月1日至2017年1月31日于广东省河源市和平县人民医院及暨南大学附属第一医院因POP就诊的21例患者为研究对象，并纳入研究组，所有患者均接受腹腔镜下子宫腹直肌前鞘悬吊固定术。选择同期于上述2家医院就诊并接受阴式全子宫切除术＋阴道前、后壁修补术的17例POP患者纳入对照组。采用盆腔脏器脱垂定量分度法(POP-Q)对2组患者POP程度进行评估，并对2组患者术前及研究组患者术后第4天进行POP-Q评分系统中Aa、Ba、Ap、Bp及C点共计5个指示点进行测量。采用成组t检验，对2组患者手术时间、术中出血量及住院时间进行比较。采用配对t检验，对研究组患者术前与术后POP-Q评分系统5个指示点测定结果比较。采用Wilcoxon秩和检验，对2组患者子宫脱垂、阴道前壁脱垂和阴道后壁脱垂POP-Q分度构成比进行比较。采用Fisher确切概率法，对2组患者术后总客观复发率进行比较。本研究遵循的程序符合广东省河源市和平县人民医院及暨南大学附属第一医院人体试验委员会制定的伦理学标准，得到该委员会批准，并与所有受试者签署临床研究知情同意书。

①2组患者的年龄、产次、绝经年限及人体质量指数(BMI)等一般情况比较，差异均无统计学意义(P>0.05)。②2组患者的子宫脱垂、阴道前壁脱垂及阴道后壁脱垂的POP-Q分度构成比比较，差异均无统计学意义(P>0.05)。③研究组患者的手术时间为(76.7±15.6)min，显著短于对照组的(123.8±17.9)min；研究组患者的术中出血量为(37.9±6.4)mL，显著低于对照组的(138.8±28.9)mL；研究组患者的住院时间为(6.3±2.8)d，显著短于对照组的(9.4±3.8)d，2组上述指标分别比较，差异均有统计学意义(t＝－8.654, P<0.001; t＝－14.150, P<0.001; t＝－2.452, P＝0.023)。④研究组术前与术后第4天POP-Q评分系统测定结果显示，Aa点分别位于(－0.5±1.3)cm与(－2.3±0.5)cm处，Ba点分别位于(2.1±1.6)cm与(－1.9±0.4)cm处，Ap点分别位于(－1.1±1.3)cm与(－2.8±0.3)cm处，Bp点分别位于(0.3±1.8)cm与(－2.6±0.4)cm处，C点分别位于(3.6±1.7)cm与(－7.7±0.6)cm处，上述测定结果分别比较，差异均有统计学意义(t＝12.408、14.791、6.355、8.820、28.302, P<0.001)。⑤研究组和对照组患者的总客观复发率分别为33.3%(7/21)和23.5%(4/17)，2组比较，差异无统计学意义(P＝0.167)。

腹腔镜下子宫腹直肌前鞘悬吊固定术治疗POP安全有效，并且在手术时间、术中出血量及术后住院时间较阴式全子宫切除术＋阴道前、后壁修补术具有明显优势，但是腹腔镜下子宫腹直肌前鞘悬吊固定术的远期疗效仍有待多中心、随机对照研究进一步证实。

To investigate the clinical efficacy and safety of laparoscopic uterine suspension and fixation to anterior sheath of rectus abdominis in the treatment of pelvic organ prolapse (POP).

From October 1, 2014 to January 31, 2017, a total of 21 POP patients who received laparoscopic uterine suspension and fixation to anterior sheath of rectus abdominis were included into study group. Meanwhile, another 21 POP patients who received vaginal hysterectomy and vaginal wall repair surgery were included into control group. Patients of both two groups were admitted to Heping County People′s Hospital and First Affiliated Hospital of Jinan University. The degree of POP was assessed by the pelvic organ prolapse quantification (POP-Q), and 5 indicators of Aa, Ba, Ap, Bp and C points of the POP-Q scoring system were measured before the operation of two groups and at the 4th day after operation of study group. The operation duration, intraoperative blood loss and hospital stay between two groups were compared by independent-samples t test. Five indicators of Aa, Ba, Ap, Bp and C points of the POP-Q scoring system were measured by paired-samples t test. The constituent ratio of POP-Q degrees of uterine prolapse, anterior vaginal wall prolapse and posterior vaginal wall prolapse were compared by Wilcoxon rank sum test. The objective recurrence rates between two groups were detected by Fisher exact test. The study protocol was approved by the Ethnical Review Board of Investigation in Human Beings of Heping County People′s Hospital and First Affiliated Hospital of Jinan University. Informed consent was obtained from each participant.

① There were no significant differences between two groups in general clinical characteristics such as age, parity, menopause duration and body mass index (BMI) (P>0.05). ② There were no significant differences between two groups in constituent ratio of POP-Q degrees of uterine prolapse, anterior vaginal wall prolapse and posterior vaginal wall prolapse (P>0.05). ③ The operation duration in study group was (76.7±15.6)min, which was significant shorter than (123.8±17.9) min in control group, intraoperative blood loss in study group was (37.9±6.4) mL, which was significant less than (138.8±28.9) mL in control group, hospital stay in study group was (6.3±2.8) d, which was significant shorter than (9.4±3.8) d, and all the above differences were statistically significant (t=-8.654, P<0.001; t=-14.150, P<0.001; t=-2.452, P=0.023). ④ The results of POP-Q scoring system in study group before the operation and at the 4th day after the operation were as follows. Point Aa (point in the anterior vaginal wall, 3 cm from hymen) were located at (-0.5±1.3) cm and (-2.3±0.5) cm, point Ba (point in the anterior vaginal prolapse) were located at (2.1±1.6) cm and (1.9±0.4)cm, point Ap (point in the posterior vaginal wall, 3 cm from hymen) were located at (-1.1±1.3) cm and (-2.8±0.3) cm, point Bp (point in the posterior vaginal prolapse, farthest from hymen) were located at (0.3±1.8) cm and (-2.6±0.4) cm, point C (point in the anterior fornix of vagina or vaginal stump) were located at (3.6±1.7) cm and (-7.7±0.6) cm, respectively; and all the differences between two groups were statistically significant (t=12.408, 14.791, 6.355, 8.820, 28.302; P<0.001). ⑤ The objective recurrence rates of two groups were 33.3% (7/21) and 23.5% (4/17), and the difference between them was not statistically significant (P=0.167).

The surgery of laparoscopic uterine suspension and fixation to anterior sheath of rectus abdominis is a safe and effective approach for the treatment of POP. Compared with traditional operation, it has obvious advantages in the aspects of operation duration, intraoperative blood loss and postoperative hospital stay, but the long-term complications remain to be followed up.