腹腔镜耻骨固定术治疗盆腔器官脱垂的长期解剖学和功能结果。
Long-term anatomical and functional results of laparoscopic promontofixation for pelvic organ prolapse.
机构信息
Centre Hospitalier Universitaire de Sherbrooke, Quebec, Canada.
出版信息
BJU Int. 2010 Sep;106(6):861-6. doi: 10.1111/j.1464-410X.2009.09173.x. Epub 2010 Jan 19.
OBJECTIVE
To assess the long-term anatomical and functional outcomes of laparoscopic promontofixation (LP) for pelvic organ prolapse (POP), and the long-term safety of LP, as POP is a common problem in women of all ages, with treatment including vaginal, abdominal, laparoscopic or robot-assisted surgical approaches.
PATIENTS AND METHODS
This was a retrospective study of the first consecutive 186 women who underwent LP for POP, with or without stress urinary incontinence (SUI), from January 1998 to December 2002 in one centre. Those patients with concurrent SUI had LP with a Burch colposuspension or tension-free vaginal tape (TVT). The recurrence rate of POP was evaluated by physical examination at follow-up visits and by the patients, using a postal, unvalidated self-applied questionnaire (SAQ). Patients' urinary, sexual and digestive functions, overall satisfaction about surgery and quality of life, were evaluated with SAQ.
RESULTS
All 186 patients had LP, with concomitant Burch (25) or TVT (100) procedures. The median (interquartile range) follow-up was 60 (48-71) months. In all, 71% of the patients attended their follow-up visits and the success rate was 92.4%. Eight patients were re-operated because of recurrent POP. The SAQ response rate was 95%; 91.1% and 79.8% of responders were satisfied or very satisfied after their surgery, and with their quality of life, respectively; women were unsatisfied or very unsatisfied because of recurrence of POP (seven), urinary symptoms (five) or constipation (two). Patients complained of recurrent POP (10.8%), persistent or recurrent UI (27.3% of the women treated with Burch and 21.1% with TVT), and transient constipation (20%). Over half of the women (50.6%) were not sexually active and 5.4% developed dyspareunia. The long-term complication rate was 6%; there were five vaginal mesh erosions.
CONCLUSION
POP treated with LP offers excellent long-term results with low recurrence and morbidity rates, and a good quality of life.
目的
评估腹腔镜耻骨固定术（LP）治疗盆腔器官脱垂（POP）的长期解剖学和功能结果，以及 LP 的长期安全性，因为 POP 是各年龄段女性的常见问题，其治疗方法包括阴道、腹部、腹腔镜或机器人辅助手术。
患者和方法
这是一项回顾性研究，纳入了 1998 年 1 月至 2002 年 12 月在一家中心接受 LP 治疗的 186 例 POP 患者（伴或不伴压力性尿失禁[SUI]）。同时患有 SUI 的患者接受 LP 联合 Burch 耻骨悬吊术或无张力阴道吊带术（TVT）。通过随访时的体格检查和患者的邮寄、未经验证的自我应用问卷（SAQ）评估 POP 的复发率。患者的尿、性和消化功能、对手术的整体满意度和生活质量，采用 SAQ 进行评估。
结果
所有 186 例患者均接受 LP 治疗，同时行 Burch（25 例）或 TVT（100 例）手术。中位（四分位间距）随访时间为 60（48-71）个月。共有 71%的患者参加了随访，成功率为 92.4%。8 例患者因 POP 复发而再次手术。SAQ 应答率为 95%；91.1%和 79.8%的应答者对手术后和生活质量表示满意或非常满意；因 POP 复发（7 例）、尿症状（Burch 治疗者中有 5 例，TVT 治疗者中有 21.1%）和便秘（2 例）而不满意或非常不满意。患者抱怨 POP 复发（10.8%）、持续性或复发性 UI（Burch 治疗者中有 27.3%，TVT 治疗者中有 21.1%）和短暂性便秘（20%）。超过一半的女性（50.6%）无性生活，5.4%出现性交痛。长期并发症发生率为 6%；有 5 例阴道网片侵蚀。
结论
LP 治疗 POP 具有出色的长期效果，复发率和发病率低，生活质量高。
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