切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (06) : 362 -366. doi: 10.3877/cma.j.issn.1674-6899.2020.06.010

所属专题: 文献

论著

腹腔镜线性单侧髂耻韧带悬吊术治疗中盆腔器官脱垂
张庆霞1, 阳艳军1, 王扬1, 梁静1, 凌斌1, 陈庆云,1   
  1. 1. 100029 北京,中日友好医院妇产科
  • 收稿日期:2020-10-19 出版日期:2020-12-30
  • 通信作者: 陈庆云

Laparoscopic unilateral pectopexy in the treatment of middle pelvic organ prolapse

Qingxia Zhang1, Yanjun Yang1, Yang Wang1, Jing Liang1, Bin Ling1, Qingyun Chen,1   

  1. 1. Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2020-10-19 Published:2020-12-30
  • Corresponding author: Qingyun Chen
引用本文:

张庆霞, 阳艳军, 王扬, 梁静, 凌斌, 陈庆云. 腹腔镜线性单侧髂耻韧带悬吊术治疗中盆腔器官脱垂[J/OL]. 中华腔镜外科杂志(电子版), 2020, 13(06): 362-366.

Qingxia Zhang, Yanjun Yang, Yang Wang, Jing Liang, Bin Ling, Qingyun Chen. Laparoscopic unilateral pectopexy in the treatment of middle pelvic organ prolapse[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(06): 362-366.

目的

探讨腹腔镜线性单侧髂耻韧带悬吊术治疗中盆腔器官脱垂的可行性、安全性和临床结局。

方法

选取2015年6月至2017年6月在中日友好医院妇科因POP-Q评分≥Ⅱ度且中盆腔器官脱垂为主行腹腔镜线性单侧髂耻韧带悬吊术20例,比较术前与术后36个月的POP-Q评分、生活质量评分(盆底功能障碍问卷-20、盆底疾病生活质量影响问卷短表-7),统计患者围手术期参数和临床疗效。

结果

20例患者均成功完成手术,术中均无肠管等脏器损伤,术后随访(49±6)个月,1例发生尿潴留,未发现缝线暴露等并发症。术后36个月复查根据POP-Q分期法测定脱垂均无复发,解剖治愈率100%。POP-Q的Aa、Ba、Ap、Bp、C和TVL各项上,术前与术后36个月差异均有统计学意义(P<0.01);术前及术后36个月生活质量评分PFDI-20[(91.06±25.02)分比(25.17±8.10)分]及PFIQ-7 [(98.42±25.36)分比(24.98±9.02)分],差异均有统计学意义(P<0.01),主观满意度为100%。

结论

腹腔镜线性单侧髂耻韧带悬吊术为治疗中盆腔缺陷提供新的思路和选择,其微创、简单、安全、有效,容易学习和掌握,仍需大型随机对照研究来进一步观察远期疗效及并发症。

Objective

To study the efficiency and safety of laparoscopic unilateral pectopexy which uses sling suspension in the treatment of middle pelvic organ prolapse.

Methods

20 patients who underwent laparoscopic unilateral pectopexy(a sling suspension without mesh) due to middle pelvic prolapse with POP-Q score above II was analyzed in our department from Jun. 2015 to Jun. 2017.The clinical efficacy were evaluated by comparing the POP-Q score, PFDI-20 and PFIQ-7 questionnaires before operation and 36 months after operation to understand the subjective satisfaction.

Results

The operations were successfully completed in the 20 patients.No injuries of rectum or other organs occurred.One case of postoperative urine retention was cured one week later. The Aa, Ba, Ap, Bp , C and TVL of POP-Q were significantly different before and 12 months after operation (P<0.01) or before and 36 months after operation (P<0.01). There were significant differences in PFDI-20[(91.06±25.02)vs (25.17±8.10)] and PFIQ-7 [(98.42±25.36) vs (24.98±9.02)] scores before operation and 36 months after operation (P<0.01). Subjective satisfaction was 100%.

Conclusions

Laparoscopic unilateral pectopexy, a sling suspension without mesh, is a new method for the treatment of middle pelvic organ prolapse, which is safe, effective and easier to learn. Large randomized controlled trial are still needed to further observe the long-term efficacy and complications.

图1 手术操作步骤
表1 20例中盆腔器官脱垂患者术前和术后36个月的POP-Q分度测量值[M(P25P75)]
表2 20例中盆腔器官脱垂患者术前和术后36个月生活质量评分比较(分,±s)
图2 解剖图
1
Whitehead WE, Bradley CS, Brown MB, et al. Gastrointestinal complications following abdominal sacrocolpopexy for advanced pelvic organ prolapse [J]. Am J Obstet Gynecol,2007,197(1): 71-78.
2
Sauerwald A, Niggl M, Puppe J, et al. Laparoscopic pectopexy: a biomechanical analysis [J]. PLoS One ,2016,11(2):e0144143. DOI:10.1371/journal.pone.0144143
3
Banerjee C, Noe KG. Laparoscopic pectopexy: a new technique of prolapse surgery for obese patients [J]. Arch Gynecol Obstet ,2011,284(3):631-635.
4
Noe KG, Schiermeier S, Alkatout I, et al. Laparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy-postoperative results and intermediate-term follow-up in a pilot study [J]. J Endourol, 2015,29(2):210-215.
5
陈飞,胡清,刘冬霞,等. 髂耻韧带固定术纠正中盆腔缺陷的短期疗效评价[J]. 中国实用妇科与产科杂志,2019,35(5): 584-588.
6
芦珍珍,王璐,栗浩然,等.腹腔镜下全子宫切除加髂耻韧带悬吊术治疗中盆腔器官脱垂的疗效分析[J]. 现代妇产科进展,2020,29(7): 522-526,530.
7
Margulies RU, Lewicky-Gaupp C, Fenner DE, et al. Complications requiring reoperation following vaginal mesh kit procedures for prolapse[J]. Am J Obstet Gynecol ,2008,199(6):678-674.
8
Maher CF, Feiner B, De Cuyper EM, et al. Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial[J]. Am J Obstet Gynecol,2011,204(4):360-367.
9
Cheng YW, Su TH, Wang H, et al. Risk factors and management of vaginal mesh erosion after pelvic organ prolapse surgery[J]. Taiwan J Obstet Gynecol,2017,56(2):184-187.
10
赵成志,卢深涛,王荥,等. 腹腔镜骶骨固定术相关并发症的回顾:7年单中心临床分析[J/CD]. 中华腔镜外科杂志(电子版),2020,13(4):223-228.
11
刘天航,孙秀丽. 髂耻韧带悬吊术治疗中盆腔缺陷的应用进展[J]. 中国妇产科临床杂志,2019,20(2): 183-185.
12
Kale A, Biler A, Terzi H, et al. Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery[J]. Int Braz J Urol,2017,43(5):903-909.
13
Tahaoglu AE, Bakir MS, Peker N, et al. Modified laparoscopic pectopexy: short-term follow-up and its effects on sexual function and quality of life[J]. International urogynecology journal ,2018,29(8):1155-1160.
14
Cezarino BN. Editorial comment: laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery[J]. Int Braz J Urol,2017,43(5):910-910.
15
梁海燕,陈纲,于欢,等. 应用线性悬吊术治疗子宫脱垂[J]. 中华医学杂志,2014,94(21): 1664-1666.
16
Cosson M, Boukerrou M, Lacaze S, et al. A study of pelvic ligament strength[J]. Eur J Obstet Gynecol Reprod Biol, 2003,109(1):80-87.
17
洪华兴,陈海啸,洪正华,等. Corona Mortis血管解剖学研究及其临床意义[J]. 中国骨伤,2006,19(6):355-357.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[9] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[10] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[11] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[12] 冯旺, 马振中, 汤林花. CT扫描三维重建在肝内胆管细胞癌腹腔镜肝切除术中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 104-107.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文
0
HTML PDF
最新录用 在线预览 正式出版 最新录用 在线预览 正式出版
0 0 0 0 0 0


摘要
56
最新录用 在线预览 正式出版
0 0 56
  来源 本网站 其他网站
  次数 25 31
  比例 45% 55%