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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2022, Vol. 18 ›› Issue (01) : 80 -86. doi: 10.3877/cma.j.issn.1673-5250.2022.01.011

论著

新式阴道前、后壁联合修补术临床分析
杨一君1,1, 漆苏婉2,2, 石灿1,1, 姜旖3,3, 王婷1,1, 高迎春1,†,1()   
  • 收稿日期:2021-10-08 修回日期:2021-11-20 出版日期:2022-02-01
  • 通信作者: 高迎春

Clinical analysis of modified anterior and posterior vaginal wall joint repair

Yijun Yang1,1, Suwan Qi2,2, Can Shi1,1, Yi Jiang3,3, Ting Wang1,1, Yingchun Gao1,1,†()   

  • Received:2021-10-08 Revised:2021-11-20 Published:2022-02-01
  • Corresponding author: Yingchun Gao
  • Supported by:
    National Natural Science Foundation of China(81702566); Project of Jiangsu Maternal and Child Health Association(FYX202117); Huai′an Health Research Project(HAWJ201903); Huai′an Natural Sciences Research Projects(HAB202105); Science and Technology Development Fund of Nanjing Medical University(NMUB2019347); Development Funds of the Affiliated Hospital of Xuzhou Medical University(XYFM2021035); Education Research Projects of the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University(hyyjy2021011)
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杨一君, 漆苏婉, 石灿, 姜旖, 王婷, 高迎春. 新式阴道前、后壁联合修补术临床分析[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(01): 80-86.

Yijun Yang, Suwan Qi, Can Shi, Yi Jiang, Ting Wang, Yingchun Gao. Clinical analysis of modified anterior and posterior vaginal wall joint repair[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(01): 80-86.

目的

探讨新式阴道前、后壁联合修补术治疗盆腔脏器脱垂(POP)的临床效果。

方法

选择2017年1月至2021年1月，于南京医科大学附属淮安第一医院接受手术治疗的120例POP患者为研究对象。根据采用的手术方式，将其分为研究组(n＝60，采用新式阴道前、后壁联合修补术)及对照组(n＝60，采用腹腔镜下全子宫双侧附件切除术+传统阴道前、后壁修补术)。采用独立样本t检验及χ2检验，对2组患者一般临床资料，术中及术后情况进行统计学比较。本研究经南京医科大学附属淮安第一医院医学伦理委员会批准(审批文号：YX-P-2020-023-01)。所有患者知情同意并与之签署临床研究知情同意书。

结果

①2组POP患者年龄、人体质量指数(BMI)、产次、绝经者比例及POP脱垂程度比较，差异均无统计学意义(P>0.05)。②研究组POP患者手术时间、术中出血量、总住院时间、术后住院时间及住院费用分别为(88.0±30.6) min、(24.7±36.0) mL、(7.3±2.1) d、(4.6±1.4) d及(10 727±1 812)元，均短于或低于对照组的(118.0±33.4) min、(56.7±43.8) mL、(9.8±2.3) d、(6.4±1.6) d及(26 318±3 890)元，并且差异均有统计学意义(t＝5.130、4.372、6.218、6.558、28.138，均为P<0.001)。2组POP患者术后3、6、12个月复发率构成比比较，差异无统计学意义(P>0.05)。

结论

新式阴道前、后壁联合修补术在不增加POP患者术后复发率的基础上，不仅能缩短手术时间、减少患者术中出血量，还可以缩短住院时间、减少住院费用，并且易于操作，适宜推广。

关键词: 盆腔脏器脱垂, 阴道前、后壁修补术，改良, 腹腔镜, 治疗应用, 保留子宫, 女(雌)性
Objective

To explore clinical effect of modified anterior and posterior vaginal wall joint repair in treatment of pelvic organ prolapse (POP).

Methods

From January 2017 to January 2021, a total of 120 POP patients who received surgical treatment in the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University were chosen as research subjects. According to surgical methods, they were divided into observation group (n=60, patients received modified vaginal anterior and posterior wall joint repair) and control group (n=60, patients received laparoscopic hysterectomy with bilateral adnexectomy plus traditional anterior and posterior vaginal wall repair). The general clinical data, intraoperative and postoperative conditions of patients were statistically compared between two groups by independent-samples t test and chi-square test. This study was approved by the Medical Ethics Committee of the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University (Approval No. YX-P-2020-023-01), and all patients signed the informed consents.

Results

① There were no significant differences between two groups of POP patients in age, body mass index (BMI), parity, proportion of menopause and POP prolapse degree (P>0.05). ② The operating duration, volume of intraoperative bleeding, total average length of hospital stay, average postoperative length of hospital stay and cost of hospitalization in observation group were (88.0±30.6) min, (24.7±36.0) mL, (7.3±2.1) d, (4.6±1.4) d and (10 727±1 812) yuan, respectively, which were shorter or less than those of (118.0±33.4) min, (56.7±43.8) mL, (9.8±2.3) d, (6.4±1.6) d and (26 318±3 890) yuan, respectively in control group, and the differences were statistically significant (t=5.130, 4.372, 6.218, 6.558, 28.138; all P<0.001). There was no significant difference in constituent ratio of 3, 6, 12 months′ recurrence rate of POP after surgery between two groups (P>0.05).

Conclusions

On the basis of no increasing in postoperative recurrence rate of POP, the modified vaginal anterior and posterior wall joint repair could not only shorten operation duration and reduce volumes of intraoperative bleeding, but also shorten the length of hospital stay and reduce cost of hospitalization, which is easy to operate and suitable for popularization and application.

Key words: Pelvic organ prolapse, Colporrhaphia anterior-posterior, modified, Laparoscopes, Therapeutic uses, Reserve uterus, Female
图1 1例POP-Q Ⅲ度患者(58岁)新式阴道前、后壁联合修补术主要手术步骤的术中照片图与示意图[图1A、1I：纵行切开阴道前壁黏膜；图1B、1J：将阴道前壁从膀胱筋膜分离；图1C、1K：充分分离阴道膀胱间隙，上端位于阴道横沟水平、2侧达耻骨降支水平、下端位于膀胱底宫颈附着处稍下方；图1D、1L："烧杯形"切开阴道后壁黏膜，使下1/3黏膜呈正三角形，上2/3黏膜呈宽约1.0 cm的长方形，分离阴道后壁黏膜直至穹窿部位；图1E、1M：上推膀胱，采用7#丝线于耻骨降支水平呈"U"型间断缝合双侧阴道壁筋膜组织，使膀胱完全位于阴道筋膜的上方；图1F、1N：采用2-0可吸收线连续兜底自阴道纵行切口顶端呈"U"型全层缝合阴道壁直至切口的下缘(示意图中红色实线及虚线表示缝线)；图1G、1O：修剪缝合缘处多余阴道壁组织后，采用2-0可吸收线连续锁边缝合阴道前壁黏膜；图1H、1P：采用2-0可吸收线连续锁边缝合阴道后壁黏膜]注：图1A~1H为照片图，图1I~1P为示意图。POP-Q为盆腔脏器脱垂定量
表1 2组POP患者一般临床资料比较
组别 例数 年龄(岁，±s) BMI(kg/m2，±s) 产次[例数(%)] 绝经[例数(%)] POP-Q分度[例数(%)]
1次 2次 ≥3次 Ⅱ度 Ⅲ度 Ⅳ度
研究组 60 57.3±9.0 23.6±2.0 10(16.7) 30(50.0) 20(33.3) 43(71.6) 14(23.3) 32(53.3) 14(23.3)
对照组 60 60.0±9.9 23.0±2.3 8(13.3) 38(63.3) 14(23.3) 46(76.6) 16(26.6) 26(43.3) 18(30.0)
检验值   t＝1.548 t＝1.730 χ2＝2.220 χ2＝0.960 χ2＝1.254
P值   0.124 0.086 0.329 0.327 0.534
表2 2组POP患者术中及术后情况比较
组别 例数 手术时间(min，±s) 术中出血量(mL，±s) 总住院时间(d，±s) 术后住院时间(d，±s) 住院费用(元，±s) 术后复发[例数(%)]
3个月 6个月 12个月
研究组 60 88.0±30.6 24.7±36.0 7.3±2.1 4.6±1.4 10 727±1 812 0(0) 0(0) 1(1.7)
对照组 60 118.0±33.4 56.7±43.8 9.8±2.3 6.4±1.6 26 318±3 890 0(0) 2(3.3) 3(5.0)
检验值   t＝5.130 t＝4.372 t＝6.218 t＝6.558 t＝28.138 χ2＝0.259
P值   <0.001 <0.001 <0.001 <0.001 <0.001 0.611
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