Clinical effects and mechanical mechanisms of different autologous tissue pelvic floor reconstruction techniques
不同自体组织盆底重建技术的临床效果及力学机制研究

摘要

目的 探讨交叉缝合、骶韧带悬吊、圆韧带悬吊3种自体组织盆底重建技术治疗盆腔脏器脱垂（POP）的临床效果及力学机制。方法 选取2021年—2024年63例POP患者，分3组行对应术式，比较手术指标、复发率及盆底力学指标。结果 三组术后并发症发生率差异无统计学意义（P>0.05）；A组术后尿管留置时间、住院时间均低于B组、C组，差异有统计学意义（P<0.05）；A组术中出血量高于B、C组，差异有统计学意义（P<0.05）；术后1、3个月三组复发率差异无统计学意义（P>0.05）；术后6、12个月A组复发率低于B组、C组，B组复发率高于C组，P＜0.05；差异有统计学意义（P<0.05）；术后12个月A组复发率最低（4.76%），B组复发率最高（14.29%）；术后6个月A组手测盆底肌力分级、盆底肌持续收缩压、阴道最大压力均高于B组、C组，术后6个月A组超声提示阴道顶端位于参考线上高于BC组，肛提肌裂孔面积、肛提肌周长小于BC组。差异有统计学意义（P<0.05）；A组手测盆底肌力分级、盆底肌持续收缩压高于B组，差异有统计学意义（P<0.05）。结论 交叉缝合术临床效果佳，力学支撑强，可优先推广。

Abstract

Objective To investigate the clinical efficacy and mechanical mechanism of three autologous tissue pelvic floor reconstruction techniques, namely cross suture, sacral ligament suspension, and circular ligament suspension, for the treatment of pelvic organ prolapse (POP).
Methods 63 POP patients from 2021 to 2024 were selected and divided into three groups for corresponding surgical procedures. Surgical indicators, recurrence rates, and pelvic floor mechanics indicators were compared.
Results There was no statistically significant difference in the incidence of postoperative complications among the three groups (P>0.05); The postoperative indwelling time and hospitalization time of Group A were lower than those of Group B and Group C, and the difference was statistically significant (P<0.05); The intraoperative bleeding in group A was higher than that in groups B and C, and the difference was statistically significant (P<0.05); There was no statistically significant difference in the recurrence rate among the three groups at 1 and 3 months after surgery (P>0.05); The recurrence rate of Group A was lower than that of Group B and Group C at 6 and 12 months after surgery, while the recurrence rate of Group B was higher than that of Group C, P＜0.05； The difference was statistically significant (P<0.05); At 12 months after surgery, Group A had the lowest recurrence rate (4.76%), while Group B had the highest recurrence rate (14.29%); Six months after surgery, the hand measured pelvic floor muscle strength grading, pelvic floor muscle sustained systolic pressure, and maximum vaginal pressure in Group A were higher than those in Group B and Group C. Six months after surgery, ultrasound in Group A showed that the vaginal apex was located at the reference line higher than that in Group BC, while the anal sphincter hiatus area and circumference were smaller than those in Group BC. The difference was statistically significant (P<0.05); The hand measured pelvic floor muscle strength grading and pelvic floor muscle sustained systolic pressure in Group A were higher than those in Group B, and the difference was statistically significant (P<0.05).
Conclusion   Cross suturing has good clinical efficacy, strong mechanical support, and can be prioritized for promotion.