子宫托治疗对症状性盆腔器官脱垂患者抑郁状态的影响研究  

Effect of pessary treatment on depressive symptoms in patients with symptomatic pelvic organ prolapse

作　　者：马聪聪 周莹[1] 张也 马懿迪 王媛 田维杰 叶扬 崔屹然 朱兰[1] Ma Congcong;Zhou Ying;Zhang Ye;Ma Yidi;Wang Yuan;Tian Weijie;Ye Yang;Cui Yiran;Zhu Lan(Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Beijing 100730,P.R.China)

机构地区：[1]中国医学科学院北京协和医院妇产科,北京100730

出　　处：《中国计划生育和妇产科》2021年第12期66-69,共4页Chinese Journal of Family Planning & Gynecotokology

基　　金：国家自然科学基金重点项目(项目编号:81830043);中国医学科学院医学与健康科技创新工程(项目编号:2017-12M-1-002);十三五重点研发计划(项目编号:2018YFC2002201)。

摘　　要：目的评估症状性盆腔器官脱垂(pelvic organ prolapse,POP)患者子宫托治疗前后抑郁状态的改变。方法前瞻性纳入2018年12月至2020年1月北京协和医院妇科行子宫托治疗的症状性POP患者。所有患者均提供环形带膜和牛角型子宫托,对试戴成功的患者随访3个月。采用中文验证后的抑郁症筛查量表(Patient Health Questionnare,PHQ-9)评估患者治疗前后的抑郁状态,得分越高表示抑郁症状越严重,总分为27分。患者得分≥10分为中度及以上抑郁,定义为抑郁组;<10分为无或轻微抑郁,定义为非抑郁组。结果218例症状性POP患者接受子宫托治疗,其中5例患者因无法回答问卷被排除,50例患者治疗失败,最终163例患者试戴成功并完成3个月随访。抑郁患者在治疗成功组(30/163,18.4%)和失败组(7/50,14.0%)的比例比较,差异无统计学意义(P=0.108)。完成随访的163例患者中,治疗前抑郁组合并泌尿系症状的患者比例明显高于非抑郁组。抑郁组合并尿失禁、尿急患者为60%;非抑郁组合并尿失禁患者36.8%,合并尿急患者39.1%;两者差异均有统计学意义(P<0.05)。子宫托治疗3个月后,抑郁障碍患病率明显下降,由治疗前的18.4%降为4.9%,差异有统计学意义(P<0.001)。抑郁障碍患者PHQ-9评分由治疗前的中位数14.5分降至治疗后5分,差异有统计学意义(P<0.001)。戴托并发症发生最多的是阴道分泌物增多,组间比较差异无统计学意义(P=0.648)。结论症状性POP患者中抑郁障碍的患病率为18.4%,合并尿失禁、尿急等泌尿系症状可能增加抑郁障碍的发生。子宫托治疗对缓解患者抑郁状态有效,子宫托治疗3个月后,POP患者抑郁障碍的患病率接近一般老年群体患病率。Objective To evaluate the effect of pessary treatment on depressive symptoms in patients with symptomatic pelvic organ prolapse(POP).Methods Patients with symptomatic POP who underwent pessary treatment in the Department of Gynecology of Beijing Union Medical College Hospital from December 2018 to January 2020 were prospectively included.All patients were provided with annular band membrane and ox horn uterine support.The patients who successfully tried on were followed up for 3 months.The Chinese validated depression screening scale(PHQ-9)was used to evaluate the depression status of patients before and after treatment.The higher the score,the more serious the depression,with a total score of 27 points.Patients with scores≥10 were classified as moderate and above depression,which was defined as depression group,whose scores<10 was divided into no or mild depression,defined as non depression group.Results 218 symptomatic POP patients were treated with pessary,five patients were excluded because they could not answer the questionnaire,50 patients failed the treatment,and finally 163 patients tried to wear successfully and completed the 3-month follow-up.Depressed patients ratio did not differ significantly between treatment success(30/163,18.4%)and failure(7/50,14.0%)groups(P=0.108).Of the 163 patients who completed follow-up,the proportion of patients with combined urinary symptoms was significantly higher in the depression group before treatment than in the non depression group.60%in depressed patients combined with urinary incontinence and urgency;36.8%nondepressed patients combined urinary incontinence,39.1%patients combined urinary urgency;both differences were statistically significant(P<0.05).After 3 months of pessary treatment,the prevalence of depressive disorders decreased significantly,from 18.4%before treatment to 4.9%,which was significantly different(P<0.001).The PHQ-9 scores of the depressed patients decreased from median of 14.5 points before treatment to 5 points after treatment,and the differen

关 键 词：症状性盆腔器官脱垂 子宫托 精神心理影响 抑郁症筛查量表 

分 类 号：R711[医药卫生—妇产科学]