Huang Ling-Xiao, Li Ren-Liang, Sha Li-Xiao, Lin Xiao-Hua
Department of Gynecology, People's Hospital of Wenzhou, Wenzhou, Zhejiang, China.
Medicine (Baltimore). 2018 Oct;97(42):e12765. doi: 10.1097/MD.0000000000012765.
This study aims to search for a new, economic, convenient, and low recurrence rate operation for the surgical management of pelvic organ prolapse (POP). The clinical value of the operation for treating POP was determined through retrospective case series. The new operation was called, pelvic autologous tissue reconstruction.Women with symptomatic uterine prolapse, who required surgery, were recruited. A total of 97 women [stage III to IV, according to POP quantification (POP-Q) staging] were collected from January 2010 to December 2016. Among these women, 61 women underwent a traditional operation (TO, vaginal hysterectomy and vaginal anterior and posterior wall repair), while the remaining women underwent pelvic autologous tissue reconstruction.First, there was no statistically significant difference in intraoperative blood loss, indwelling urethral catheter time, in-hospital time, and the time of passage of gas through the anus between the pelvic autologous reconstruction (PAR) and TO groups (P > .05). The average operation time in the PAR group was significantly longer than that in the TO group (P < .05). Second, ultrasonic parameters before and after the operation between the 2 groups were compared. The postoperative rotation angle of the urethra (UR), posterior vesicourethral angle (PVA), and bladder neck descent (BND) significantly decreased in the PAR group (P < .05). There was no statistically significant difference in UR between before and 12 months after surgery in the TO group (P > .05). Furthermore, BND increased in the TO group at 12 months after the operation, compared with that at 3 months after the operation (P < .05). There was no significant difference in PVA and UR before the surgery and at 3 and 12 months after the surgery between the 2 groups (P > .05). In addition, BND was significantly smaller in the PAR group than in the TO group at 3 and 12 months after the surgery (P < .05). Third, there was no statistically significant difference in PFIQ-7 and PISG-12 in both groups after surgery.The stability of the pelvic floor structure was better in the PAR group than in the TO group. Furthermore, PAR is better for preventing the occurrence of pelvic floor prolapse and stress urinary incontinence after surgery.
本研究旨在寻找一种用于盆腔器官脱垂（POP）手术治疗的新型、经济、便捷且复发率低的手术方式。通过回顾性病例系列研究确定该手术治疗POP的临床价值。这种新型手术被称为盆腔自体组织重建术。招募有症状且需要手术治疗的子宫脱垂女性患者。从2010年1月至2016年12月共收集了97名女性患者[根据盆腔器官脱垂定量（POP-Q）分期为III至IV期]。在这些女性患者中，61名接受了传统手术（TO，经阴道子宫切除术及阴道前后壁修补术），其余患者接受了盆腔自体组织重建术。首先，盆腔自体组织重建术（PAR）组与TO组在术中失血量、留置导尿管时间、住院时间及肛门排气时间方面无统计学显著差异（P>0.05）。PAR组的平均手术时间显著长于TO组（P<0.05）。其次，比较两组手术前后的超声参数。PAR组术后尿道旋转角度（UR）、膀胱尿道后角（PVA）及膀胱颈下移（BND）显著降低（P<0.05）。TO组手术前与术后12个月的UR无统计学显著差异（P>0.05）。此外，与术后3个月相比，TO组术后12个月的BND增加（P<0.05）。两组手术前及术后3个月和12个月的PVA及UR无显著差异（P>0.05）。另外，术后3个月和12个月时，PAR组的BND显著小于TO组（P<0.05）。第三，两组术后的PFIQ-7和PISG-12无统计学显著差异。PAR组盆底结构的稳定性优于TO组。此外，PAR在预防术后盆底脱垂和压力性尿失禁的发生方面效果更佳。
