关键词: 盆腔器官脱垂, 骶主韧带复合体交叉悬吊术, 骶棘韧带悬吊术, 前盆腔膨出, 骶骨主韧带复合体, 耻骨阴道肌

Abstract: Objective To explore the relative efficacy and value of the combination of traditional surgical methods with cross suspension of the sacro–uterine ligament complex and sacrospinous ligament suspension（SSLF）in preventing the recurrence of anterior pelvic prolapse after surgery. Methods This study retrospectively analyzed the clinical data of 80 patients with severe pelvic organ prolapse in Lu’an Hospital Affiliated to Anhui Medical University from January 2019 to March 2021. In the control group,patients received traditional transvaginal hysterectomy,repair of the anterior and posterior vaginal walls,and sacrospinous ligament suspension,while in the observation group,cross suspension of the sacro–uterine ligament complex was added on the basis of traditional surgical methods. The patients participating in the study were divided into the observation group（40 cases）and the control group（40 cases）according to different surgical methods. All patients with pelvic organ prolapse（POP）included in this study had POP–Q scores of grade II to IV. We compared the perioperative indicators of the two groups,including operation time,intraoperative blood loss,postoperative morbidity （defined as a body temperature exceeding 38°C for two consecutive times within 24 hours after surgery,separated by 4 hours）,postoperative indwelling catheterization time,postoperative hospital stay,and intraoperative and postoperative complications. In addition,patients were followed up by telephone and outpatient reexamination after surgery at 3 months,6 months,1 year,and 2 years. The quality of life was evaluated using the Pelvic Floor Dysfunction Symptom Questionnaire （PFDI–20） and the Pelvic Floor Disease Quality of Life Impact Questionnaire （PFIQ–7）. Results Comparing the operation time,intraoperative blood loss,and postoperative indwelling catheterization time of the two groups,there were statistically significant differences,P<0. 05. The intraoperative blood loss in the observation group was less than that in the control group,the operation time was shorter than that in the control group,and the indwelling catheter time was shorter than that in the control group. There was no statistically significant difference in postoperative hospital stay and postoperative morbidity（within 24 hours after surgery,two consecutive times with a body temperature exceeding 38°C separated by 4 hours）between the two groups,P>0. 05. There was no statistically significant difference in preoperative PFIQ–7 and PFDI–20 scores between the two groups（P>0. 05）,however,the scores of the observation group were higher than those of the control group 2 years after surgery,and the difference was statistically significant（P<0. 05）. Conclusions Traditional transvaginal hysterectomy + repair of the anterior and posterior vaginal walls + sacrospinous ligament suspension and cross suspension of the sacro–uterine ligament complex based on traditional surgical methods are both common surgical methods for the clinical treatment of severe pelvic organ prolapse. Studies have shown that the latter has a higher subjective and objective cure rate and a lower recurrence rate in the treatment of severe pelvic organ prolapse,with a more durable therapeutic effect. In addition,cross suspension of the sacro–uterine ligament complex has significant advantages in improving anterior pelvic prolapse after simple SSLF,providing new ideas for the treatment and prognosis of pelvic organ prolapse in clinical practice.

Key words: pelvic organ prolapse, cross suspension of sacrocardinal ligament complex, sacrospinous ligament suspension, anterior pelvic prolapse, sacral cardinal ligament complex, pubovaginal muscle