目的 分析经阴道自然腔道内镜手术（V-NOTES）下自体组织重建对盆腔器官脱垂（POP）患者的有效性及安全性。 方法 选取2022年9月至2024年9月我院行V-NOTES下自体组织重建的136例POP患者为研究对象，术后1年根据盆腔器官脱垂定量分期法（POP-Q）将患者分为客观治愈组（n=122）和未治愈或复发组（n=14）。多因素 Logistic 回归分析治疗结局影响因素及并发症危险因素。 结果 根据POP-Q评分，治疗后，0度患者108例（79.41%），Ⅰ度患者14例（10.29%），Ⅱ度患者9例（6.62%），Ⅲ度患者5例（3.38%），术后客观治愈率为89.71%。并发症共发生30例（22.06%）。术前高C反应蛋白（CRP）水平（OR=1.587，95%CI：1.369~1.785，P<0.001）、术前高白细胞（WBC）水平（OR=2.657，95%CI：1.695~5.269，P<0.001）、术前PA低水平（OR=0.589，95%CI：0.327~0.853，P<0.001）是POP治疗后未治愈或复发的独立危险因素。患者全子宫切除术既往手术史（OR=1.256，95%CI：1.128~3.187，P<0.001）、子宫肌瘤剔除术既往手术史（OR=2.654，95%CI：1.659~4.558，P<0.001）、术前CRP水平较高（OR=3.118，95%CI：2.147~5.436，P<0.001）是并发症风险的独立危险因素。 结论 V-NOTES自体组织修复作为一种新兴的治疗策略，在治疗POP方面显示出较高的安全性和有效性，术前控制炎症反应和保持良好营养状态对治疗效果具有积极作用。
Abstract
Objective To analyze the effectiveness and safety of autologous tissue reconstruction via vaginal natural orifice transluminal endoscopic surgery (V-NOTES) in patients with pelvic organ prolapse (POP). Methods A total of 136 POP patients who had V-NOTES autologous tissue repair performed at our facility between September 2022 and September 2024 were enrolled into the research subjects. According to the pelvic organ prolapse quantitative staging method (POP-Q), the patients were split into two groups one year following surgery: an objective cure group (n=122) and a non-cure or recurrence group (n=14). Multivariate logistic regression was used to analyze the determinants of treatment outcome and risk variables for complications. Results According to POP-Q score, after treatment, 108 patients (79.41%) were at grade 0, 14 patients (10.29%) at grade I, 9 patients (6.62%) at grade II, and 5 patients (3.38%) at grade III. The objective cure rate after the operation was 89.71%. Complications occurred in 30 cases (22.06%). Preoperative high C-reactive protein (CRP) level (OR=1.587, 95%CI: 1.369-1.785, P<0.001), preoperative high white blood cell (WBC) level (OR=2.657, 95%CI: 1.695-5.269, P<0.001), and preoperative low PA level (OR=0.589, 95%CI: 0.327-0.853, P<0.001) were independent risk factors for non-cure or recurrence after POP treatment. The patient's previous surgical history of total hysterectomy (OR=1.256, 95%CI: 1.128-3.187, P<0.001) and previous surgical history of myomectomy (OR=2.654, 95%CI: 1.659-4.558, P<0.001) and a higher preoperative CRP level (OR=3.118, 95%CI: 2.147-5.436, P<0.001) were independent risk factors for complications. Conclusions V-NOTES autologous tissue repair, as an emerging treatment strategy, showed high safety and effectiveness in the treatment of POP. Controlling the inflammatory response and maintaining a good nutritional status before the operation had a positive effect on the treatment outcome.
关键词
盆腔器官脱垂 /
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经阴道自然腔道内镜手术 /
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自体组织重建 /
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有效性
Key words
Pelvic organ prolapse /
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Vaginal natural orifice transluminal endoscopic surgery /
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Autologous tissue reconstruction /
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Effectiveness
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基金
徐州市科技局项目2023年度医药卫生面上项目（KC23349）
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