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目的比较经阴道改良盆底重建术中切除子宫与保留子宫的临床疗效及对患者生活质量的影响。方法收集2009-2013年在我院接受经阴道改良盆底重建术的患者临床资料,切除子宫组(concomitant hysterectomy group,CH)71例,保留子宫组(uterus conservation group,UC)53例。比较手术时间等围手术期参数;采用盆腔器官脱垂分度(POP-Q)评估患者术前的脱垂情况及术后的手术效果;以盆底疾病生活质量影响问卷(pelvic floor impact questionnaire-short form 7,PFIQ-7)、盆底功能障碍疾病相关问卷(pelvic floor distress inventory short form 20,PFDI-20)评价手术对患者生活质量的影响。结果两组患者手术时间、术中出血量、手术费用比较,差异有统计学意义(P<0.05)。两组患者术后的POP-Q值及POP-Q分期均较术前有明显改善;两组术后PFIQ-7和PFDI-20评分均较术前有显著降低(P<0.05),但两组术后以上参数比较差异无统计学意义(P>0.05)。术后患者有性生活的UC组9例和CH组8例;两组术后PISQ-12评分差异无统计学意义(P>0.05)。结论经阴道改良盆底功能重建术中选择保留子宫不影响手术疗效。
Objective To compare the clinical efficacy of transvaginal modified pelvic floor reconstruction in the removal of the uterus and retention of the uterus, and the impact on quality of life in patients. Methods Clinical data of patients undergoing transvaginal pelvic floor reconstruction in our hospital from 2009 to 2013 were collected. Seventy-one cases of concomitant hysterectomy group (CH) were resected and 53 cases of uterus conservation group (UC) were reserved. The perioperative parameters such as operative time were compared. The pelvic organ prolapse index (POP-Q) was used to evaluate the preoperative prolapse and the postoperative operative effect. The pelvic floor impact questionnaire- short form 7, PFIQ-7) and pelvic floor distress inventory short form 20 (PFDI-20) were used to evaluate the effect of surgery on the quality of life of patients. Results There was significant difference in operation time, intraoperative blood loss and operation cost between the two groups (P <0.05). The postoperative POP-Q and POP-Q staging were significantly improved in both groups compared with those before operation. The scores of PFIQ-7 and PFDI-20 in both groups were significantly lower than those before operation (P <0.05) There was no significant difference in the above parameters between the two groups (P> 0.05). There were 9 cases in UC group and 8 cases in CH group after surgery. There was no significant difference in postoperative PISQ-12 score between the two groups (P> 0.05). Conclusion Transvaginal pelvic floor reconstruction to choose to retain the uterus does not affect the surgical efficacy.