摘要
目的探究子宫脱垂患者行阴式子宫切除术联合阴道前后壁修补术术后合并压力性尿失禁的相关影响因素,为子宫脱垂患者的个体化治疗提供临床参考依据。方法选取2017年1月至2019年1月,天长市中医院住院行阴式子宫切除术联合阴道前后壁修补术的患者50例,术前患者已排除急性尿失禁、压力性尿失禁等情况,术后所有患者均顺利出院,术后随访2个月,根据患者的主观症状,体格检查结果、国际尿失禁咨询委员会尿失禁问卷简表以及尿动力学检查诊断并统计术后新发压力性尿失禁患者并对可能造成术后新发压力性尿失禁的因素进行统计分析。结果(1)子宫脱垂患者行阴式子宫切除术联合阴道前后壁修补术治疗后新发压力性尿失禁患者15例,其中主观症状较为明显患者5例,主观症状及体格检查均无明显异常患者6例,完成问卷量表后方才明确诊断,经尿动力学检查方才明确诊断患者4例。(2)单因素分析发现糖尿病史、体质量指数、巨大胎儿分娩史、盆腔手术史是影响术后新发压力性尿失禁的相关影响因素。(3)以术后是否发生尿失禁作为因变量(0=未发生,1=发生),将单因素分析中有统计学差异的4个影响因素纳入多因素Logistic回归分析,结果显示糖尿病病史、盆腔手术病史以及巨大胎儿分娩史是阴式子宫切除联合阴道前后壁修补术术后新发压力性尿失禁的独立危险因素。结论对于合并巨大胎儿分娩史、盆腔手术史、糖尿病病史的子宫脱垂患者可于术前加强与患者的沟通交流,告知患者术后出现新发压力性尿失禁的风险,并在完善相关评估后建议患者同步性抗尿失禁手术以综合改善患者预后,提高患者术后生活质量。
Objective To explore the related factors of stress urinary incontinence in patients with uterine prolapse after vaginal hysterectomy combined with anterior and posterior vaginal wall repair.Methods From January 2017 to January 2019,we selected 50 patients who were hospitalized in Tianchang hospital Traditional Chinese Medicine for vaginal hysterectomy and the anterior and posterior vaginal walls repair.The patients were excluded from acute urinary incontinence and stress urinary incontinence before operation.All patients were discharged smoothly after operation.The patients were followed up for 2 months.According to the subjective symptoms,physical examination results and urinary incontinence questions of the international urinary incontinence Advisory Committee The international consultation on Incontinence Questionnaire-short form(ici-q-sf)and urodynamic examination were used to diagnose and count the patients with new stress urinary incontinence after operation,and the factors that may cause new stress urinary incontinence after operation were analyzed.Results(1)15 cases of new stress urinary incontinence were treated by vaginal hysterectomy combined with anterior and posterior vaginal wall repair,of which 5 cases had obvious subjective symptoms,6 cases had no obvious abnormality in subjective symptoms and physical examination,the diagnosis was confirmed only after completing the questionnaire,and 4 cases were confirmed by urodynamic examination.(2)Univariate analysis showed that the history of diabetes mellitus,BMI,history of giant fetus delivery,and history of pelvic surgery were the related factors influencing the new onset of stress urinary incontinence.(3)With the occurrence of urinary incontinence as a dependent variable(0=not occurred,1=occurred),four factors with statistical differences in single factor analysis were included in the multivariate logistic regression analysis.The results showed that the history of diabetes mellitus,pelvic surgery and the history of giant fetus delivery were independent risks of new onset stress urinary incontinence after vaginal hysterectomy combined with anterior and posterior vaginal wall repair Factor.Conclusion For the patients with uterine prolapse who have the history of fetal delivery,pelvic surgery and diabetes mellitus,we can strengthen the communication with the patients before the operation,and inform the patients of the risk of new onset of stress urinary incontinence after the operation,and after improving the relevant evaluation,we suggest that the patients should have synchronous anti urinary incontinence operation to improve the prognosis and quality of life.
作者
曹为英
赵树娟
Cao Weiying;Zhao Shujuan(Department of Gynecology and Obstetrics,Tianchang Hospital of Traditional Chinese Medicine,Tianchang 239300,Anhui,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2020年第1期63-66,共4页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
基金
滁州市拟推荐2020年省重点研发计划项目
关键词
子宫脱垂
阴式子宫切除术
阴道前后壁修补术
新发压力性尿失禁
Uterine prolapse
Vaginal hysterectomy
Repair of anterior and posterior wall of vagina
New stress urinary incontinence
