摘要目的 分析改良腹腔镜下阴道骶骨固定术的临床疗效,评价其对盆腔器官脱垂治疗的有效性和安全性.方法 回顾性分析2008年1月至2012年9月在广州医科大学附属第一医院因盆腔器官脱垂行改良腹腔镜下阴道骶骨固定术的66例患者的临床资料,比较手术前、后盆腔器官脱垂定量(POP-Q)分度法各指示点位置,评价总体客观治愈率及复发率.通过盆底功能障碍性疾病症状问卷简表(PFDI-20)等相关问卷评分评价主观治愈率以及术后尿失禁相关症状改善情况.结果 63例患者获得6 ～57个月的随访,中位随访时间16个月,主观治愈率95％ (60/63).术后POP-Q各指示点可达解剖复位,总体客观治愈率90％ (57/63),总复发率10％ (6/63).术后中位阴道长度为7.5 cm,较术前的8.0cm稍有缩短,两者比较,差异有统计学意义(P＜0.01)；术后PFDI-20中位评分为21分,较术前的75分明显改善,两者比较,差异有统计学意义(P＜0.05)；术后随访＞3年、＞2～≤3年、＞1～≤2年、＞0.5～1年患者间POP-Q各指示点及相关问卷评分比较,差异均无统计学意义(P＞0.05).23例压力性尿失禁与5例混合性尿失禁患者改良腹腔镜下阴道骶骨固定术同时行经闭孔无张力尿道中段悬吊带术者15例,未行者13例,两者术后尿失禁治愈率分别为14/15、10/13.结论 改良腹腔镜下阴道骶骨固定术主、客观治愈率高,不仅能达到解剖学复位,还能显著提高患者术后生命质量,术后疗效稳定.

abstractsObjective To study clinical curative effect and complications of modified laparoscopic sacral colpopexy and evaluate the efficacy and safety of this procedure in treatment of pelvic organ prolapse (POP).Methods From Jan.2008 to Sept.2012,66 patients who had undergone modified laparoscopic sacral colpopexy for POP in the first affiliated hospital of Guangzhou medical university were studied retrospectively.Primary outcomes were assessed with POP quantitation (POP-Q) system that was measured before or after operation respectively to evaluate the objective cure rate and recurrence rate.Secondary outcomes were measured by the pelvic floor distress inventory short form (PFDI-20) to evaluate the subjective cure rate,as well as to evaluate the improvement of postoperative lower urinary tract symptoms.Results Sixty-three patients were followed up for 6 to 57 months,and the median follow-up time was 16 months,the overall objective cure rate was 95％ (60/63).Postoperative each indicator point was reset anatomically according to POP-Q,the overall objective cure rate was 90％ (57/63),and the total recurrence rate was 10％ (6/63).The median postoperative vaginal length was slightly shortened than preoperative length[7.5 cm versus 8.0 cm,P ＜ 0.01]; the median score of postoperative PFDI-20 was obviously improved compared to the preoperative (21 versus 75 scores,P ＜ 0.05) ; there was no statistically significant difference in POP-Q staging and questionnaire score at more than 3 years,＞ 2-≤ 3 years,＞1-≤2 years,＜0.5-1 year after operation(P ＞0.05).Among 23 patients with stress urinary incontinence (SUI) and 5 patients with mixed urinary incontinence (MUI),15 cases underwent transvaginal tension free vaginal tape-obturator (TVT-O) procedure simultaneously,13 cases did not.The cure rate of SUI was 14/15 and 10/13,respectively.Conclusions Modified laparoscopic sacral colpopexy can not only reach the anatomical replacement stage but significantly improve the postoperative quality of life with high subjective and objective cure rate and few complications.The long-term curative effect is stable.