阴道封闭术对老年盆腔器官脱垂患者肠道功能的影响及相关因素  

Effect of colpocleisis on bowel function in elderly patients with pelvic organ prolapse

作　　者：庄新荣[1] 李杰 高秀娟[1] 张桂香[1] ZHUANG Xinrong;LI Jie;GAO Xiujuan(Second Department of Gynecology,Affiliated Hospital of Chengde Medical University,Hebei,Chengde 067000,China)

机构地区：[1]承德医学院附属医院妇二科,河北省承德市067000

出　　处：《河北医药》2024年第20期3178-3181,共4页Hebei Medical Journal

摘　　要：目的探讨阴道封闭术对老年盆腔器官脱垂患者肠道功能的影响,分析术后肠道功能改善的相关因素。方法收集2020年6月至2022年6月因盆腔器官脱垂行阴道封闭术患者104例的临床及盆底超声资料,应用盆底功能障碍问卷(PFDI-20)于术前、术后12个月进行肠道症状及生活质量调查,分析肠道症状。结果104例患者中,56.7%(59/104)的患者术前至少存在一项肠道症状,术后38.5%(40/104)的患者至少存在一项肠道症状;其中梗阻性排便功能障碍术后为37.5%(39/104)较术前50.5%(52/104)明显缓解,差异有统计学意义(P<0.05),而失禁性肠道症状和刺激性肠道症状术后发生率较术前虽有下降,但差异无统计学意义(P>0.05)。术前59例有肠道症状者术后62.7%(37/59)得以改善,33.9%(20/59)的患者症状持续存在,3.4%(2/59)的患者出现症状加重。45例术前无任何肠道症状患者中术后出现任一肠道症状7例,术后新发肠道症状发生率为15.6%。术后对阴道封闭术后悔者2例,后悔率1.9%(2/104)。应用PFDI-20中的手助排便和结直肠肛门困扰量表(CRADI-8)评分,梗阻性症状中位评分术前16.67分(16.67,41.67),术后8.33分(0,16.67),术后评分较术前显著下降(P<0.05);而失禁性症状和疼痛/刺激性症状术前与术后比较差异无统计学意义(P>0.05)。多因素分析显示,存在直肠膨出者行阴道封闭术后肠道症状缓解率较高;阴道封闭术同时行会阴体修补是肠道症状缓解的保护因素(OR 0.151,95%CI:0.035~0.645)。结论阴道封闭术可有效改善老年盆腔器官脱垂患者的梗阻性排便症状,新发肠道症状较少见,合并直肠膨出的POP患者行阴道封闭术同时行会阴体修补术有助于缓解肠道症状。Objective To investigate the effect of colpocleisis on bowel function in elderly patients with pelvic organ prolapse(POP),and to analyze influencing factors for improving postoperative bowel function.Methods Clinical data and pelvic floor ultrasound findings of 104 elderly patients who underwent colpocleisis for POP from June 2020 to June 2022 were collected.Bowel function,quality of life,and bowel symptoms before and 12 months after surgery were assessed using the Pelvic Floor Distress Inventory-Short Form 20(PFDI-20).Results Among 104 patients enrolled in this study,56.7%(59/104)had at least one preoperative bowel symptom and 38.5%(40/104)had at least one postoperative bowel symptom.Obstructive bowel dysfunction was significantly improved after surgery(P<0.05).The incidences of postoperative incontinence bowel symptom and irritating bowel symptom decreased without significant differences(P>0.05).Among 59 patients with preoperative bowel symptoms,62.7%(37/59)had a postoperative improvement,33.9%(20/59)had persistent symptoms,and 3.4%(2/59)had worsening symptoms.Among the 45 patients without any preoperative bowel symptoms,7(15.6%)had postoperative newly occurred bowel symptoms.There were 2(1.9%)cases who regretted to this surgery.Assessed by the grading for splinting symptom in the PFDI-20 and the Colorectal-Anal Distress Inventory 8(CRADI-8),the median score of the obstructive symptom was significantly reduced after surgery(16.67[16.67,41.67]points vs 8.33[0,16.67],P<0.05).However,there were no significant differences in the incidences of incontinence symptoms and irritating bowel symptom(P>0.05).Multivariate analysis showed that patients with rectocele had a significantly higher rate of bowel symptom improvement after surgery,and colpocleisis combined with perineoplasty was a protective factor for bowel symptom improvement(OR 0.151,95%CI:0.035-0.645).Conclusion Colpocleisis can effectively improve obstructive defecation symptoms in elderly patients with POP,with low rates of newly developed symptoms.Colpocleis

关 键 词：盆腔器官脱垂 阴道封闭术 肠道功能 生活质量 

分 类 号：R713.3[医药卫生—妇产科学]