Laparoscopic inguinal ligament suspension with uterine preservation for pelvic organ prolapse: A retrospective cohort study
Laparoscopic inguinal ligament suspension with uterine preservation for pelvic organ prolapse: A retrospective cohort study
复制标题
腹腔镜保留子宫腹股沟韧带悬吊术治疗盆腔器官脱垂：一项回顾性队列研究
DOI：
10.1016/j.ijsu.2018.04.020
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发表时间：
2018-06-01
影响因子：
15.3
通讯作者：
Dai, Zhiyuan
中科院分区：
文献类型：
--
作者：
Li, Chunbo;Shu, Huimin;Dai, Zhiyuan
目的：介绍一种保留子宫的腹腔镜腹股沟韧带悬吊术（LILS）的替代手术技术，并评价其对严重盆腔器官脱垂（POP）患者的疗效和安全性。方法：2014年6月至2015年12月，对35例有症状的Ⅲ期或Ⅳ期患者进行保留子宫的LILS治疗。记录围手术期参数，包括手术时间、失血量、住院时间和并发症。根据盆腔器官脱垂问卷（POP-Q）评估来评估解剖治愈率。通过动态磁共振成像（MRI）分析解剖点。记录经过验证的盆底不适量表（PFDI-20）、盆底影响问卷（PFIQ-7）和盆腔器官脱垂性尿失禁性问卷（PISQ-12），以评估症状严重程度、生活质量和性活动。结果：平均手术时间为163.8+/-42.3分钟（范围：120-280） 分钟），平均估计失血量为 48.6 +/- 60.5 毫升（范围：10-200 毫升），平均住院时间为 5 天（范围：3-7 天）。术中未出现并发症。术后6个月和12个月的解剖成功率分别为97.1%和94.3%。与基线相比，动态 MRI 显示术后用力解剖点有显着改善。术后 6 个月和 12 个月，症状严重程度、生活质量和性活动也出现显着改善。经过至少12个月的随访，术后无并发症发生，复发脱垂率低。结论：对于希望保留子宫的患者来说，保留子宫的LILS是治疗POP的可行、有效和安全的手术替代方案。需要来自大型研究的更长时间的随访数据来证实 LILS 保留子宫作为微创手术方法的益处。
Objective: To introduce an alternative surgical technique of laparoscopic inguinal ligament suspension (LILS) with uterine preservation and evaluate its efficacy and safety for patients with severe pelvic organ prolapse (POP).Methods: Between June 2014 and December 2015, 35 patients with symptomatic stage III or IV were treated by LILS with uterine preservation. The perioperative parameters including surgical time, blood loss, hospital stay and complications were recorded. The anatomical cure rate was evaluated according to the Pelvic Organ Prolapse Questionnaire (POP-Q) assessment. The anatomical points were analyzed by dynamic Magnetic Resonance Imaging (MRI). Validated questionnaire of the Pelvic Floor Distress Inventory (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7) and the Pelvic organ prolapse urinary Incontinence Sexual Questionnaire (PISQ-12) were recorded to evaluate the symptom severity, quality of life and sexual activity.Results: The mean surgical time was 163.8 +/- 42.3 min (range: 120-280 min), the mean estimated blood loss was 48.6 +/- 60.5 ml (range: 10-200 ml), and the mean hospital stay was 5 days (range: 3-7 days). No intraoperative complications were encountered. The anatomical success rate at postoperative 6-month and 12-month was 97.1% and 94.3%, respectively. The postoperative anatomical points on straining showed a significant improvement on dynamic MRI as compared to baselines. The symptom severity, quality of life and sexual activity also presented significant improvement both 6-month and 12-month after surgery. After a minimal 12 months follow-up, no postoperative complications occurred and the recurrence prolapse were low.Conclusion: LILS with uterine preservation is a feasible, effective and safe surgical alternative in the treatment of POP for patients who desire to reserve uterus. Longer follow-up data from larger studies are required to confirm the benefits of LILS with uterine preservation as a minimally invasive surgical approach.