摘要
目的:探讨盆腔器官脱垂(POP)患者行手术治疗后肠道症状改善情况。方法:收集2018年8月至2022年12月在承德医学院附属医院因POP行手术治疗的234例患者的临床资料,分别于术前、术后6个月应用盆底功能障碍问卷(PFDI-20)进行随访,对随访结果中的肠道症状进行统计分析。结果:POP患者的术前肠道症状发生率为43.6%(102/234),肠道困扰症状发生率为22.2%(52/234);术后56.9%(58/102)的患者肠道症状得到改善,39.2%(40/102)的患者肠道症状持续存在,肠道症状加重者仅为3.9%(4/102),其中梗阻性排便功能障碍术后6个月较术前有显著改善,差异有统计学意义(P<0.05),而便急、排便/排气失禁、排便疼痛、直肠脱垂的肠道症状改善不明显(P>0.05)。应用手助排便和结直肠肛门困扰量表(CARDI-8)评分可见肠道症状评分术前8.3分(2.8~22.2分),术后5.6分(2.1~11.1分),其中梗阻性症状评分术前25分(8.3~58.3),术后8.3分(0~25分),术后评分较术前有显著下降(P<0.05);失禁性症状及疼痛/刺激性症状评分术前与术后相比无统计学差异(P>0.05)。多因素分析显示,阴道后壁脱垂3~4度是术前出现手助排便(OR=3.10,95%CI为1.31~7.34)和排便不尽感(OR=2.63,95%CI为1.15~5.99)症状的高危因素,术前存在肠道症状是术后发生肠道症状的高危因素(OR=20.98,95%CI为10.26~42.93)。重建性手术与封闭性手术在改善患者肠道症状方面无显著差异(P>0.05)。结论:POP患者中肠道症状较常见,梗阻性排便功能障碍在阴道封闭术和盆底重建性手术后均可得到显著改善,其他肠道症状术后改善不明显。
Objective:To investigate the effects of surgical treatment for patients with pelvic organ prolapse(POP)on bowel symptoms.Method:234 patients who underwent surgical treatment for POP were collected in Affiliated Hospital of Chengde Medical University from August 2018 to December 2022.The patients were followed up with pelvic floor dysfunction questionnaire(PFDI-20)before operation and 6 months after operation,and the bowel symptoms were statistically analyzed.Results:The incidence of preoperative bowel symptom was 43.6%,and the incidence of bothersome bowel symptom was 22.2%.56.9%patients had improved bowel symptoms after surgery,39.2%patients had persistent bowel symptoms,and only 3.9%patients had worsened bowel symptoms.Obstructive bowel dysfunction improved significantly 6 months after surgery(P<0.05).However,there was no statistically significant in the improvement of fecal incontinence,pain with defecation,fecal urgency and rectal prolapse(P>0.05).Application of Colorectal-anal distress inventory 8(CARDI-8)score showed that the total score of bowel symptom was 8.3 points(2.8~22.2)before operation and 5.6 points(2.1~11.1)after operation,the obstructive symptom score was 25 point(8.3~58.3)before operation and 8.3 points(0~25)after operation,the postoperative score was significantly lower than that before operation(P<0.05).There was no statistically difference between preoperative and postoperative scores of incontinence and pain/irritation symptoms(P>0.05).Multivariate analysis showed that posterior vaginal prolapse with 3~4 stage was risk factor of splinting(OR=3.10,95%CI:1.31~7.34)and incomplete emptying(OR=2.63,95%CI:1.15~5.99).Preoperative bowel symptom is the high-risk factor for postoperative occurrence of bowel symptom(OR=20.98,95%CI:10.26~42.93).No difference in symptom improvement was identified between reconstructive surgery and colpocleisis(P>0.05).Conclusion:Bowel symptoms are common in patients with POP,obstructive defecation dysfunction can be significantly improved after reconstructive surgery or colpocleisis,but other bowel symptoms are not significantly improved.
作者
庄新荣
李杰
张雅丽
高秀娟
张桂香
Zhuang Xinrong;Li Jie;Zhang Yali(Gynecology 2 Department,Affiliated Hospital of Chengde Medical University,Chengde 067000)
出处
《现代妇产科进展》
2024年第2期104-108,共5页
Progress in Obstetrics and Gynecology
关键词
盆腔器官脱垂
肠道症状
手术治疗
Pelvic organ prolapse
Bowel symptoms
Surgery treatment
