盆腔器官脱垂患者术前尿动力学检查的价值探讨  

The value of urodynamics in pelvic organ prolapse women with stress urinary incontinence

作　　者：王润之[1] 孙秀丽[1] 王世言[1] 曹婷婷[1] 杨欣[1] 王建六[1] 

机构地区：[1]北京大学人民医院妇产科,100044

出　　处：《中国妇产科临床杂志》2016年第2期103-105,共3页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：中华预防医学会"中国妇女盆底功能障碍"防治专项资金(2119000216)

摘　　要：目的探讨尿动力学检查(UDS)在盆腔器官脱垂(POP)患者中的应用价值。方法回顾性分析2012年1月至2013年12月在北京大学人民医院妇科接受盆底重建手术的348例POP患者的临床资料。根据是否同时合并压力性尿失禁(SUI)将患者分为POP+SUI组和单纯POP组。结果 1 348例POP患者中,142例(40.8%)合并SUI,其中111例患者术前接受UDS检查,但仅有52.3%(58/111)的患者表现为尿动力学SUI(UDS-SUI)。196例单纯POP组患者中,158例行术前UDS检查,8例(5.1%)表现为UDS-SUI,提示隐匿性SUI。2 POP+SUI组中,73例同时行抗尿失禁手术,69例未同时行抗尿失禁手术,术后SUI持续或加重者分别为4.1%(3/73)和29.0%(20/69)。单纯POP组中193未行预防性抗尿失禁手术,术后53例出现不同程度SUI,术后新发SUI(De novo SUI)27.5%(53/193)。单纯POP组中,3例UDS-SUI患者接受抗利尿手术,术后无SUI;5例未行抗尿失禁手术者术后均出现SUI症状。结论对于POP合并单纯SUI患者,无论UDS是否见腹压漏尿,均推荐盆底重建手术同时行抗尿失禁手术,因此术前可不做UDS检查。术前无SUI症状者UDS有助于发现隐匿性SUI,指导手术方式选择,推荐行UDS检查。POP合并复杂下尿路症状者应接受UDS检查。Objective We aimed to determine the value of preoperative urodynamic results in POP patients with stress urinary incontinence（SUI）.Methods We retrospectively studied 348 women with anterior prolapse（≥stage 2,POPQ-stage）treated with pelvic floor reconstructive surgery in Peking University Peoples Hospital from January 2012 to December 2013.Patients were divided into POP＋SUI group and POP group according to weather the POP patients accompanied with SUI or not.Results 40.8%（142/348）patients presented with symptoms of SUI.There were 142 cases in POP＋SUI group,111 of them received UDS preoperatively,only 52.3%（58/111）of them showed SUI in UDS.158 patients of the 196 cases in POP group received UDS and 8UDS-SUI was found with the occult SUI rate of 5.1%（8/158）.73 patients in POP＋SUI group underwent simultaneous sling and 69 cases had POP repair only.At average 12.6 months follow-up,SUI persisted or worsen in 4.1%（3/73）and29.0%（20/69）,respectively.Among the 196 patients in POP group,3of the 8UDS-SUI patients underwent simultaneous sling and no de novo SUI occurred.Other 193 cases who underwent pelvic reconstruction surgery only showed 27.5%（53/193）De novo SUI.In the 8occult SUI patients,5did not undergo simultaneous sling and100%（8/8）developed postoperative De novo SUI.Conclusions UDS findings and symptoms were poorly correlated.In POP patients with symptomatic simple SUI,simultaneous sling is recommended and preoperative UDS become unnecessary.Because of the existence of occult SUI,urodynamics could be used to evaluate patients with POP who do not have clinical SUI.UDS should be performed in POP patients with complex LUTS.

关 键 词：尿动力学检查 盆腔器官脱垂 压力性尿失禁 抗尿失禁手术 

分 类 号：R713[医药卫生—妇产科学]