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目的探讨腹腔镜子宫腹壁线型悬吊固定术(LUAS)治疗子宫脱垂的方法和临床疗效。方法选择2015年3月至2016年6月四川省江油市人民医院26例盆腔脏器脱垂定量分度法(POP-Q)2级以上,中位数年龄64岁,同时有临床症状的患者进行LUAS。观察手术时间、术中出血量、术后并发症发生率及子宫脱垂治愈率。比较手术前及术后6个月POP-Q值和生活质量问卷[盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)和盆底功能障碍性疾病相关问卷20(PFDI-20)]。手术成功的定义为主观治愈,且以POP-Q为疗效评价的客观标准,POP-Q≥2度为复发,无脱垂为治愈。结果 26例均成功完成手术,术中出血量10~150 ml,中位数51 ml;手术时间30~150 min,中位数100 min。行LUAS后的26例患者均未有阴道内组织物脱出,主观治愈率100%。术后6个月,POP-Q测量值均较术前明显改善(P均<0.01),达到解剖学治愈;PISQ-12、PFDI-20评分亦较术前明显改善(P均<0.01)。均无严重并发症发生。结论 LUAS治疗子宫脱垂具有手术创伤小、手术时间短、简单安全、疗效好等优点。
Objective To investigate the method and clinical efficacy of laparoscopic linear abdominal wall suture fixation (LUAS) for uterine prolapse. Methods From March 2015 to June 2016, 26 patients with pelvic organ prolapse quantitative index (POP-Q) grade 2 or more and median age 64 years old with clinical symptoms were selected from Jiangyou People’s Hospital of Sichuan Province from March 2015 to June 2016. Perform LUAS. Observation of operation time, intraoperative blood loss, postoperative complications and uterine prolapse cure rate. The POP-Q and quality of life questionnaire [PISQ-12 and PFDI-20] were compared before and 6 months after surgery. . Surgical success was defined as subjective cure, and with POP-Q as an objective measure of efficacy, POP-Q≥2 degrees was recurrent and no prolapse was cured. Results All the 26 cases were successfully operated. The blood loss was 10 ~ 150 ml and the median was 51 ml. The operation time was 30-150 min with a median of 100 min. None of the 26 patients who underwent LUAS had vaginal tissue prolapse, with a subjective cure rate of 100%. At 6 months after operation, the measured values of POP-Q were significantly improved compared with that before operation (all P <0.01), which were cured by anatomy. The scores of PISQ-12 and PFDI-20 were also significantly improved (P <0.01). No serious complications occurred. Conclusions LUAS has the advantages of less trauma, shorter operation time, simple and safe treatment and good curative effect in the treatment of uterine prolapse.