摘要目的 探讨经阴道子宫骶骨韧带高位悬吊术(HUS)治疗重度盆腔器官脱垂(POP)的长期主、客观疗效.方法 2003年6月至2013年3月,解放军总医院第一附属医院共对136例POP定量(POP-Q)分度法Ⅲ～Ⅳ度的POP患者行经阴道子宫切除及HUS,对获得随访的125例患者的临床资料进行回顾性分析.阴道前壁修补99例(79.2％,99/125),其中前壁Ⅲ度以上脱垂者中65％(53/81)加用了网片,后壁修补80例(64.0％,80/125),后壁Ⅲ度以上脱垂者中15％(5/34)加用网片.47例术前有压力性尿失禁者同时行耻骨后或经闭孔阴道无张力尿道中段悬吊带术,96.0％(120/125)的患者同时行肛提肌及会阴体修补术.术后5年对患者的主、客观疗效进行回顾性分析,包括围手术期情况以及近远期并发症.手术客观治愈标准为脱垂器官最远端与处女膜水平的距离＜0 cm;主观改善情况通过比较患者手术前、后盆底疾病生命质量影响问卷简表(PFIQ-7)和盆底功能障碍性疾病症状问卷简表(PFDI-20)评分.结果 125例患者平均随访时间(5.4±1.2)年.术后5年中有4例患者阴道前壁轻度膨出,复发率为3.2％ (4/125),但不需再次手术及子宫托治疗.术后5年客观治愈率为96.8％(121/125),主观满意度为94.4％(118/125),PFDI-20,PFIQ-7调查问卷中位评分分别为8、7分,均较术前(分别为62、64分)明显降低(P＜0.01),提示主观症状明显改善.术中3例(2.4％,3/125)患者输尿管被缝扎.术前47例压力性尿失禁患者中术后2例症状未改善,其中1例半年后好转.2例(1.6％,2/125)新发轻度尿失禁,但不需要治疗.结论 HUS用于治疗重度POP疗效持久,主、客观治愈率高,复发率低,安全、有效,值得临床推广应用.

abstractsObjective To investigate the long-term objective and subjective outcomes of the transvaginal high uterosacral ligament suspension (HUS) in treatment of severe pelvic organ prolapse (POP).Methods From Jun.2003 to Mar.2013,136 patients with severe POP quantitation(POP-Q) stage Ⅲ-Ⅳ underwent transvaginal hysterectomy and HUS operation in the First Affiliated Hospital,General Hospital of People's Liberation Army.And 125 patients (91.9％,125/136) were followed up at a mean of 5.4 years(range of 4.2-9.2 years).Anterior colporrhaphy (79.2％,99/125),posterior colporrhaphy (64.0％,80/125),the perineorrhaphy (96.0％,120/125) and tension-free suburethral slings (37.6％,47/125) were performed concurrently,in which 53 (65％,53/81) patients with severe cystocele and 5 patients (15％,5/34) with rectocele were augmented with mesh,respectively.Concurrent operation and complications were studied.The objective success of the operation was defined as the leading vaginal edge above hymen.Subjective results were obtained quality-of-life questionnaires,including pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7).Result The mean interval of following up was (5.4 ± 1.2) years.Four patients presented mild anterior vaginal wall prolapse,and the recurrence rate were 3.2％ (4/125),but no reoperation and pessary treatment were needed.Therefore,the subjective and objective satisfaction rate was 94.4％ (118/125) and 96.8％ (121/125).The mean scores of PFDI-20 and PFIQ-7 at 5 years after the operations were 8,7,significantly lower than 62,64 (P ＜0.01).There were 3 cases of ureter obstruction.Tension-free vaginal tape was performed on 47 cases with stress urinary incontinence (SUI) as indicated.The symptom of 2 patients was not improved significantly after the operation,but one was improved after 6 months.The rate of denovo SUI was in 2(1.6％,2/125) patients,but no further treatment was needed.Conclusions The transvaginal HUS was then conformed to be a safe,minimal traumatic,highly successful and durable procedure for severe POP,so it is worthy of being popularized for clinical application.