阴道封闭术治疗重度盆腔器官脱垂老年女性的尿路症状疗效评价  

To Investigate the Improvement of Urinary Tract Symptoms in Elder Women with Severe Pelvic Organ Prolapse after Colpocleisis

作　　者：鞠蕊 杨欣[1] 孙秀丽[1] 李晓伟[1] 王建六[1] JU Rui;YANG Xin;SUN Xiuli(Departmem of Obstetrics and Gynecology,Peking University People's Hospital,Beijing Key Laboratory of Female Pelvic Floor Disorder,Female Pelvic Floor Disease Research Center of Peking University Medical Center,The Diagnosis and Treatment Center of Female Pelvic floor Disorder,Peking University People's Hospital,Beijing 100044,China;Departmem of Obstetrics and Gynecology,Beijing Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京大学人民医院妇科北京市女性盆底疾病研究重点实验室,北京大学医学部女性盆底疾病研究中心,北京大学人民医院女性盆底疾病诊疗中心,北京100044 [2]北京市垂杨柳医院妇科,北京100022

出　　处：《实用妇产科杂志》2019年第11期836-841,共6页Journal of Practical Obstetrics and Gynecology

基　　金：国家科技支撑计划课题(编号:2014BAI05B00,2015BAI13B00)

摘　　要：目的:探讨阴道封闭术治疗老年女性重度盆腔器官脱垂(POP)患者尿路症状的改善情况。方法:选择2014年1月至2017年10月北京大学人民医院采取阴道完全封闭术及阴道部分封闭术治疗老年重度POP患者286例,POP-Q法分期均为Ⅲ~Ⅳ期,分析患者手术并发症及尿路症状改善情况,并采用生活质量调查问卷(PFDI-20短表),及其分量表盆底功能障碍症状问卷排尿困扰量表(UDI-6)和盆腔器官脱垂困扰量表(POPDI-6)进行评价。结果:①286例患者年龄60~90岁,行阴道全封闭术172例,阴道部分封闭术114例。有48例同时行抗压力性尿失禁(SUI)手术。手术后平均随访时间28.30±11.70个月。随访中无POP复发者,客观治愈率100%。②手术后近远期并发症38例,发生率为13.19%(38/286)。尿潴留经保留尿管无效后电刺激治疗1例,新发SUI 13例,发生率5.86%(13/222)。③术前伴排尿困难患者45.10%(129例),与无排尿困难患者(157例)比较,术后残余尿量差异无统计学意义(47.48±54.13 ml vs 43.35±62.96 ml,P>0.05);术前有排尿困难的患者其术前尿频、尿急、下腹坠痛的比例明显高于术后发生的比例,差异均有统计学意义(P<0.05)。术前有排尿困难患者(129例)行阴道完全封闭术与行阴道部分封闭术比较,其术后自主排尿测残余尿差异无统计学意义(35.24±43.15 ml vs 33.84±40.59 ml,P>0.05)。术后新发SUI 13例中行阴道完全封闭术与行阴道部分封闭术构成比比较,差异无统计学意义(7.21%vs 6.58%,P>0.05)。④222例患者完成术后随访,阴道封闭术后PFDl-20、UDI-6、POPDl-6评分均明显低于术前(P<0.05)。而阴道完全封闭术与阴道部分封闭术术后PFDl-20、UDI-6、POPDl-6评分比较,差异均无统计学意义(P>0.05)。结论:阴道封闭术对高龄体弱、无性生活要求、不能耐受盆底重建术的老年患者,可显著改善患者POP及尿路症状,提高患者术后的生活质量。阴道完全封闭术和阴道部分封闭术Objective:To evaluate the urinary tract symptoms improvement and surgical outcomes in elder women with severe pelvic organ prolapse who had undergonecolpocleisis.Methods:From Jan.2014 to Oct.2017,286 severe POP patients assessed as stageⅢandⅣby POP-Q system underwent total and partial colpocleisis.The preoperative and postoperative quality of life were evaluated by using the PFDI-20.The urinary tract symptoms improvementwere evaluated by using the UDI-6 and POPDI-6.Results:①A total of 286 patients aged 60 to 90 years were included,172 patients underwent total colpocleisis and 114 patients underwent partial(LeFort)colpocleisis.48 patients in 286 patients underwent anti-urinary incontinence procedure.The median follow-up time was 28.30±11.70 months.There were no POP recurrence during follow-up.The objective cure rate was 100%.②The incidence of short-term and long-term complications after operation was 13.19%(38/286).One urinary retention case was treated with electrical stimulation after the catheter was ineffective.The incidence of new stress urinary incontinence after operation was 5.86%(13/222).③45.10%(129/286)of patients with dysuria before operation,compared with thosewithout dysuria,there was no significant difference in residual urine volume after surgery(47.48±54.13 ml vs 43.35±62.96 ml,P<0.05).The preoperative urinary frequency and urgency rate declined significantlyin patients with dysuria after operation(P<0.05).When total colpocleisiswas compared with LeFort in patients with dysuria,there was no statistically significant difference in postoperative residual urine volume(35.24±43.15 ml vs 33.84±40.59 ml,P>0.05).There were 13 cases suffered from new urinary incontinence.Compared the proportion of new urinary incontinence intotal colpocleisiswiththat in LeFort,the difference was not statistically significant(7.21%vs 6.58%,P>0.05).④The mean score of PFDI-20,UDI-6 and POPDl-6 after operation were significant lower than those before operation.There was no significant difference in the mean sc

关 键 词：阴道封闭术 盆腔器官脱垂 排尿障碍 生活质量 尿失禁 

分 类 号：R713.3[医药卫生—妇产科学]