Effect of transabdominal anterior rectus sheath suspension in treatment of prolapse of pelvic organs
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摘要:目的 探讨腹直肌前鞘悬吊术治疗盆腔器官脱垂的临床效果。方法 选取30例盆腔器官脱垂患者作为研究对象，均采用经腹腹直肌前鞘悬吊术治疗，术后随访12个月，观察患者的术后分期及生活质量改变情况。结果 盆腔器官脱垂定量分度法(POP-Q)测量结果显示，本组患者术后6、12个月时的阴道前壁中线距处女膜3 cm处(Aa点)、阴道顶端或前穹窿到Aa点之间阴道前壁上段中的最远点(Ba点)、宫颈或子宫切除后阴道顶端所处的最远端(C点)、有宫颈时的后穹窿位置(D点)、阴道后壁中线距处女膜3 cm处(Ap点)、阴道顶端或后穹窿到Ap点之间阴道后壁上段中的最远点(Bp点)至处女膜的距离与术前比较，差异有统计学意义(P＜0.05); 患者术后12个月的治疗有效率为85.71%。结论 经腹腹直肌前鞘悬吊术是治疗盆腔器官脱垂的有效方法，手术操作简单易学，安全可靠，且不增加患者的经济负担。Abstract:Objective To explore the clinical effect of anterior rectus sheath suspension in treatment of prolapse of pelvic organs.Methods A total of 30 patients with pelvic organ prolapse in our hospital were included in our study, and were treated by transabdominal anterior rectus sheath suspension. The changes of postoperative staging and life quality were compared after 12-month follow-up.Results Pelvic organ prolapse quantitation(POP-Q) results showed that the distances from hymen to the following points, such as the 3 cm point from medline of vaginal anterior wall to hymen(Aa point), the farthest point of anterior wall of the vagina from apex or anterior fornix of the vagina to Aa point (Ba point), the farthest point of the vagina top after cervical resection or hysterectomy(C point), position of posterior fornix in the presence of cervix (D point), 3 cm point from medline of vaginal posterior wall to hymen(Ap point), the farthest point of vaginal posterior wall of the vagina from apex or posterior fornix of the vagina to Ap point (Bp point)at postoperative 6 and 12 months showed significant differences compared with operation before(P < 0.05). The effective rate at 12 months after operation was 85.71%.Conclusion Transabdominal anterior rectus sheath suspension is an effective, reliable and safe method in the treatment of prolapse of pelvic organs, and it is an easily operated surgery.
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表 1 30例患者术前及术后POP-Q分度结果比较[n(%)]
时点 n 0度 Ⅰ度 Ⅱ度 Ⅲ度 Ⅳ度 术前 30 0 0 0 20(66.67) 10(33.33) 术后6个月 30 0 28(93.33) 2(6.67) 0 0 术后12个月 28 0 24(85.71) 4(14.29) 0 0 
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表 2 手术前后盆腔器官脱垂定量分度测量结果比较(x±s)
cm 测量点 术前(n=30) 术后6个月(n=30) 术后12个月(n=28) Aa点 2.46±0.29 -2.57±0.35* -2.47±0.50* Ba点 4.04±0.60 -2.64±0.43* -2.54±1.12* C点 3.29±1.05 -5.94±1.34* -4.87±0.57* D点 1.83±1.01 -3.54±2.37* -3.34±2.34* Ap点 2.07±0.49 -2.39±1.40* -2.28±1.36* Bp点 3.02±1.11 -2.43±1.43* -2.30±1.43* Aa点: 阴道前壁中线距处女膜3 cm处;
Ba点: 阴道顶端或前穹窿到Aa点之间阴道前壁上段中的最远点;
C点: 宫颈或子宫切除后阴道顶端所处的最远端;
D点: 有宫颈时的后穹窿的位置; Ap点: 阴道后壁中线距处女膜3 cm处;
Bp点: 阴道顶端或后穹窿到Ap点之间阴道后壁上段中的最远点。
与术前比较，*P＜0.05。
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