重度盆腔器官脱垂患者阴道封闭术后新发压力性尿失禁的影响因素  

Risk Factors of De Novo Stress Urinary Incontinence after Colpocleisis for Patients with Severe Pelvic Organ Prolapse

作　　者：周平平 王燕[1] 韩璐 严新彦 魏万玉 蒲巍林[1] ZHOU Pingping;WANG Yan;HAN Lu(Department of Urology,Gansu Provincial Maternity and Child Care Hospital,Lanzhou Gansu 730050,China)

机构地区：[1]甘肃省妇幼保健院生殖泌尿科,甘肃兰州730050

出　　处：《实用妇产科杂志》2022年第11期853-856,共4页Journal of Practical Obstetrics and Gynecology

基　　金：甘肃省科技厅重点研发计划(编号:21YF5FA026)。

摘　　要：目的:探讨重度盆腔器官脱垂(POP)患者阴道封闭术后新发压力性尿失禁(SUI)的影响因素。方法:选取2017年1月至2021年11月于甘肃省妇幼保健院生殖泌尿科因POPⅢ~Ⅳ度行阴道封闭手术并完成术后随访的104例患者临床资料进行回顾性分析,采用多因素Logistic回归分析术后新发SUI的影响因素。结果:104例患者中,术后新发SUI 22例(21.15%,22/104)(术后新发SUI组)。术后无新发SUI组与术后新发SUI组在高血压病史、术前Aa值、术前尿动力学检查(UDS)膀胱出口梗阻、术前隐匿性尿失禁(OSUI)的比较,差异有统计学意义(P<0.05)。多因素分析显示,重度POP患者阴道封闭术后新发SUI的独立危险因素包括有高血压病史(OR 4.085,95%CI 1.149~14.522,P=0.030)、术前Aa值高(OR 1.933,95%CI 1.159~3.222,P=0.012)、术前UDS膀胱出口梗阻(OR 4.439,95%CI 1.220~16.151,P=0.024)、术前UDS示OSUI(OR 4.565,95%CI 1.304~15.977,P=0.018)。结论:有高血压病史、术前Aa值高、术前UDS膀胱出口梗阻、术前UDS-OSUI是重度POP患者阴道封闭术后新发SUI的独立危险因素。对于有此类高危因素的POP患者,术前综合评估后制定合理的手术方案,必要时术中同时行抗尿失禁手术。Objective:To investigate the influencing factors of de novo stress urinary incontinence(SUI)after colpocleisis in patients with severe pelvic organ prolapse(POP).Methods:The clinical data of 104 patients who underwent colpocleisis due to POP stage Ⅲ-Ⅳ in the Department of Urology of Gansu Provincial Maternity and Child Care Hospital from January 2017 to November 2021 and completed the follow-up after surgery were selcted.Multivariate Logistic analysis was used to analyze the risk factors of de novo SUI after colpocleisis.Results:Of 104 patients, there were 22 patients(21.15%,22/104)had de novo SUI after operation.High preoperative Aa value, occulent SUI,bladder outlet obstruction, and history of hypertension were independent risk factors for de novo of SUI after surgery(P<0.05).Multivariate analysis showed that independent risk factor of de novo SUI after colpocleisis in patients with severe POP included hypertension history(OR 4.085,95%CI 1.149-14.522,P=0.030),preoperative Aa values(OR 1.933,95%CI 1.159-3.222,P=0.012),preoperative UDS bladder outlet obstruction(OR 4.439,95%CI 1.220-16.151,P=0.024),preoperative UDS-OSUI(OR 4.565,95% CI 1.304-15.977,P=0.018).Conclusions:History of hypertension, high preoperative Aa value, preoperative UDS bladder outlet obstruction, and preoperative UDS OSUI were independent risk factors for de novo SUI after colpocleisis.For POP patients with those high risk factors, a reasonable operation plan should be formulated after a comprehensive preoperative evaluation and anti-incontinence surgery should be performed simultaneously if necessary.

关 键 词：盆腔器官脱垂 阴道封闭术 新发压力性尿失禁 影响因素 

分 类 号：R711.2[医药卫生—妇产科学]