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目的探讨阴道半封闭术在老年盆腔器官脱垂的治疗效果及安全性。方法 2012年11月至2014年2月在甘肃省妇幼保健院妇科,因盆腔器官脱垂实施阴道半封闭术共31例。记录患者的一般资料、脱垂程度、围手术期参数和手术并发症,术后3个月复查,评价主客观治愈率。结果患者平均年龄(72.10±5.58)岁,合并内科疾患者占74.19%(23/31),POP定量分度法(POP-Q)均为Ⅲ~Ⅳ度。手术时间平均(79.81±32.65)min,术中出血量平均(36.77±29.00)ml,术后发热平均(1.52±1.29)d,术后24 h疼痛VAS评分平均(1.53±1.07)分,术后病率发生率12.90%(4/31),术后住院平均(5.74±2.63)d,住院总费用(12918.82±5546.65)元。按术中是否同时行子宫切除术分为两组比较,手术时间、术后VAS评分、术后住院天数、住院总费用、术后病率发生率,两组差异有统计学意义(P<0.05);术中出血量、术后发热天数、术前住院天数、术前检查费用,两组比较差异无统计学意义(P>0.05)。术后3个月,主观治愈率96.67%,客观治愈率100%。结论阴道半封闭术对于老年重度盆腔器官脱垂是安全有效的,对于术前子宫检查正常的患者是否有必要同时行全子宫切除术是有待商榷的。
Objective To investigate the curative effect and safety of vaginal semi-occlusion in senile pelvic organ prolapse. Methods From November 2012 to February 2014, 31 cases of gynecology in Gansu Provincial Maternal and Child Health Hospital and vaginal and semi-occlusion due to pelvic organ prolapse were included. The patient’s general information, degree of prolapse, perioperative parameters and surgical complications were recorded and reviewed 3 months after surgery to evaluate the subjective and objective cure rates. Results The average age of patients was 72.10 ± 5.58 years old, accounting for 74.19% (23/31) of patients with medical diseases, and POP-Q (POP-Q) were all Ⅲ ~ Ⅳ degrees. The average operation time was (79.81 ± 32.65) min, the average amount of bleeding during operation was (36.77 ± 29.00) ml, the postoperative fever was (1.52 ± 1.29) d and the pain VAS score was (1.53 ± 1.07) Incidence rate of 12.90% (4/31), postoperative hospitalization (5.74 ± 2.63) d, total cost of hospitalization (12918.82 ± 5546.65) yuan. According to whether intraoperative hysterectomy at the same time is divided into two groups, the operation time, postoperative VAS score, postoperative hospital stay, total cost of hospitalization, the incidence of postoperative morbidity, the difference between the two groups was statistically significant (P <0.05 There was no significant difference between the two groups in the amount of blood loss, days of fever, days of preoperative hospitalization, and preoperative examination (P> 0.05). After 3 months, the subjective cure rate was 96.67% and the objective cure rate was 100%. Conclusions Vaginal semi-occlusion is safe and effective for elderly patients with pelvic organ prolapse. Whether it is necessary to perform a total hysterectomy in patients with normal preoperative uterus examination remains to be discussed.