阴道壁神经分布与术后新发压力性尿失禁之间关系的研究  

作　　者：杨文娟 林益琴 孙先军 俞昊 方姗[1] 

机构地区：[1]浙江省嘉兴市妇幼保健院,314001

出　　处：《浙江临床医学》2024年第2期209-211,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省嘉兴市科技计划项目(2021AD30030)。

摘　　要：目的探讨阴道壁神经的分布及其他相关影响因素与盆底重建术后新发压力性尿失禁之间的关系。方法选择107例因盆腔脏器脱垂(POP)行手术治疗的患者,根据术后是否发生压力性尿失禁分组,采用免疫组化方法对患者阴道前壁蛋白基因产物9.5(PGP9.5)染色,探讨两组患者在绝经年龄、绝经年限、产次、血清促卵泡激素(FSH)值、脱垂程度、阴道前壁神经分布和盆底肌力评估方面是否存在差异。结果两组患者在绝经年龄、绝经年限、产次、血清FSH值方面无明显差异(P>0.05),术后新发压力性尿失禁(POSUI)组阴道前壁脱垂程度大于对照组,阴道壁神经的分布弱于对照组,盆底肌评估中快肌肌力最大值及慢肌耐力平均值均小于对照组(P<0.05),Logistic回归分析显示术前Ba值越大,POSUI发生率越高,阴道前壁神经分布越密、盆底肌力量越强,POSUI发生率越低。结论对于阴道前壁膨出严重并伴有膀胱膨出的患者需警惕POSUI的发生,POP术后改善盆底肌肉及阴道壁神经的功能可预防术后新发压力性尿失禁的发生。Objective To investigate the relationship between the distribution of vaginal wall nerves,other related influencing factors and postoperative stress urinary incontinence(POSUI)in patients after pelvic floor reconstruction.Methods 107 pelvic organ prolapse(POP)patients who underwent surgical treatment were grouped according to whether stress urinary incontinence occurred after surgery.Protein gene product 9.5(PGP 9.5)of anterior vaginal wall was stained by immunohistochemistry.The differences in menopausal age,years since menopause,parity,serum follicle-stimulating hormone(FSH),degree of prolapse,anterior vaginal wall nerve distribution and pelvic floor muscle strength assessment were analyzed among the two groups.Results The differences of age at menopause,years since menopause,parity,serum FSH values between the two groups were not significant(P>0.05).In the POSUI group,the degree of anterior vaginal wall prolapse was greater than that in the control group,the distribution of vaginal wall nerves was weaker than that in the control group(P<0.05),the maximum value of fast muscle strength and the average value of slow muscle endurance in the pelvic floor muscle evaluation were lower than those in the control group(P<0.05).Logistic regression analysis showed that the greater the preoperative Ba value,the greater the probability of POSUI,the denser the distribution of nerves in the anterior vaginal wall and the stronger the pelvic floor muscle strength,the lower the incidence of POSUI.Conclusion More attention should be paid to the occurrence of POSUI in patients with severe anterior vaginal wall swelling accompanied by cystocele,the improvement of the function of the pelvic floor muscle and vaginal wall nerve after POP surgery can prevent the occurrence of POSUI.

关 键 词：盆腔器官脱垂 术后新发压力性尿失禁 蛋白基因产物9.5 盆底肌 

分 类 号：R713[医药卫生—妇产科学]