Clinical analysis of modified anterior and posterior vaginal wall joint repair

doi:10.3877/cma.j.issn.1673-5250.2022.01.011

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(%)]
组别	例数	年龄(岁，±s)	BMI(kg/m²，±s)	1次	2次	≥3次	绝经[例数(%)]	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(%)]
组别	例数	年龄(岁，±s)	BMI(kg/m²，±s)	1次	2次	≥3次	绝经[例数(%)]	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(%)]
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)	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

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(%)]
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)	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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