女性盆底功能障碍性疾病的病因学研究及手术治疗的近期疗效观察
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摘要
研究目的：
通过调查问卷对女性盆底功能障碍性疾病(PFD)的危险因素进行分析研究；评价PFD手术治疗的近期疗效。为提高女性生活质量,及早预防和治疗女性PFD提供临床依据。
资料与方法：
随机选择在广州市南方医科大学第一附属医院南方医院与南方医科大学第三附属医院就诊及住院的患者80例为研究对象。实验组60例为PFD的患者；对照组20例为同年龄段非PFD因其它妇科疾病住院的患者。
1.行女性盆底功能障碍临床问卷调查(自编),进行临床资料收集；
2.妇科检查：常规妇检+特殊检查(指压试验、压力诱发试验、棉棍倾斜试验、POP-Q评分)；
3.手术治疗：单纯阴道前壁修补术；阴道前壁+后壁修补术；阴道前壁修补术+宫颈切除术；阴式全子宫切除术+阴道前壁修补术；阴式全子宫切除术+阴道前壁+后壁修补术；
结果：
1.21例患者为单纯阴道前壁或后壁膨出,其中合并压力性尿失禁者占52.38%；39例为子宫脱垂患者,其中合并压力性尿失禁者占57.50%；
2.实验组和对照组间BMI、平均动脉压、产次、绝经年龄、新生儿体重、产时会阴裂伤、产后休息、产后SUI、产程延长间的差异有统计学意义(P<0.05)；
3.实验组与对照组比较,两组间夜间小便次数、小便频率、尿急等症状之间的都有明显差异(P<0.05)；
4.术后尿频、尿急、SUI、阴道口自觉肿物脱出等症状都消失；术后指压试验、压力诱发试验、棉棍倾斜试验都变为阴性；POP-Q分度变为0；术后排便、排尿及生活习惯都得到了明显改善。
结论：
1.PFD是女性常见病,其发病与妊娠及分娩、肥胖、高血压疾病、绝经及便秘等密切相关,一个或多个因素可同时存在。
2.手术是PFD最有效的治疗方式。
Objectives:
Using questionnaire of pelvic floor dysfunction to analysis the Risk factor of PFD; review the short-term curative effect of the pelvic floor operation. to provide clinical bases for increase the female quality of life, and preventing and curing FPFD early.
Methods:
To random select 80 patients as research objects.60 PFD patients as experiment group;20 un-PFD patients as control group.
1. using questionnaire of pelvic floor dysfunction to collect data;
2. gynecologic examination:convention gynecologic examination+special examinat-ion;
3. operation:anterior colporrhaphy; anterior colporrhaphy+posterior colporrhaphia; anterior colporrhaphy+amputation of cervix; panhysterectomy+anterior colpor-rhaphy; panhysterectomy+anterior colporrhaphy+posterior colporrhaphia.
Result:
1. patients of paries anterior vaginase bulge or paries posterior vaginae bulge had 21 examples, patients who affiliated SUI accounting 52.38%; patients of hysteroptosis had 39 examples, patients who affiliated SUI accounting 57.50%;
2. there were significant differences between experiment group and control group about BMI、mean arterial pressure、parity、age of menostasis、the neonatal birth weight、perineal laceration、resting after childbirth、SUI after childbirth、birth process prolongation;
3. there were significant differences between experiment group and control group about urination frequency at night、urination frequency、urgency;
4. the symptom of frequent micturition、urgency、SUI、goiter emersion had disappear; special examination become negatively after operation; defaecate、emiction and living habit had obviously improve.
Conclusion:
1. PFD was the female common ailment, its invasion was closed correlated to gravidity、dilivery、obesity、hypertension、menopause、constipation, one or tow or more factors could concomitance;
2. Operation was the most effective treatment to PFD.
通过调查问卷对女性盆底功能障碍性疾病(PFD)的危险因素进行分析研究；评价PFD手术治疗的近期疗效。为提高女性生活质量,及早预防和治疗女性PFD提供临床依据。
资料与方法：
随机选择在广州市南方医科大学第一附属医院南方医院与南方医科大学第三附属医院就诊及住院的患者80例为研究对象。实验组60例为PFD的患者；对照组20例为同年龄段非PFD因其它妇科疾病住院的患者。
1.行女性盆底功能障碍临床问卷调查(自编),进行临床资料收集；
2.妇科检查：常规妇检+特殊检查(指压试验、压力诱发试验、棉棍倾斜试验、POP-Q评分)；
3.手术治疗：单纯阴道前壁修补术；阴道前壁+后壁修补术；阴道前壁修补术+宫颈切除术；阴式全子宫切除术+阴道前壁修补术；阴式全子宫切除术+阴道前壁+后壁修补术；
结果：
1.21例患者为单纯阴道前壁或后壁膨出,其中合并压力性尿失禁者占52.38%；39例为子宫脱垂患者,其中合并压力性尿失禁者占57.50%；
2.实验组和对照组间BMI、平均动脉压、产次、绝经年龄、新生儿体重、产时会阴裂伤、产后休息、产后SUI、产程延长间的差异有统计学意义(P<0.05)；
3.实验组与对照组比较,两组间夜间小便次数、小便频率、尿急等症状之间的都有明显差异(P<0.05)；
4.术后尿频、尿急、SUI、阴道口自觉肿物脱出等症状都消失；术后指压试验、压力诱发试验、棉棍倾斜试验都变为阴性；POP-Q分度变为0；术后排便、排尿及生活习惯都得到了明显改善。
结论：
1.PFD是女性常见病,其发病与妊娠及分娩、肥胖、高血压疾病、绝经及便秘等密切相关,一个或多个因素可同时存在。
2.手术是PFD最有效的治疗方式。
Objectives:
Using questionnaire of pelvic floor dysfunction to analysis the Risk factor of PFD; review the short-term curative effect of the pelvic floor operation. to provide clinical bases for increase the female quality of life, and preventing and curing FPFD early.
Methods:
To random select 80 patients as research objects.60 PFD patients as experiment group;20 un-PFD patients as control group.
1. using questionnaire of pelvic floor dysfunction to collect data;
2. gynecologic examination:convention gynecologic examination+special examinat-ion;
3. operation:anterior colporrhaphy; anterior colporrhaphy+posterior colporrhaphia; anterior colporrhaphy+amputation of cervix; panhysterectomy+anterior colpor-rhaphy; panhysterectomy+anterior colporrhaphy+posterior colporrhaphia.
Result:
1. patients of paries anterior vaginase bulge or paries posterior vaginae bulge had 21 examples, patients who affiliated SUI accounting 52.38%; patients of hysteroptosis had 39 examples, patients who affiliated SUI accounting 57.50%;
2. there were significant differences between experiment group and control group about BMI、mean arterial pressure、parity、age of menostasis、the neonatal birth weight、perineal laceration、resting after childbirth、SUI after childbirth、birth process prolongation;
3. there were significant differences between experiment group and control group about urination frequency at night、urination frequency、urgency;
4. the symptom of frequent micturition、urgency、SUI、goiter emersion had disappear; special examination become negatively after operation; defaecate、emiction and living habit had obviously improve.
Conclusion:
1. PFD was the female common ailment, its invasion was closed correlated to gravidity、dilivery、obesity、hypertension、menopause、constipation, one or tow or more factors could concomitance;
2. Operation was the most effective treatment to PFD.
引文
[1]李亚钦,宋岩峰.女性压力性尿失禁的病因及高危因素[J].福建医药杂志,2004,26(2)：139-140.
[2]杨欣,王建六.盆腔脏器脱垂的治疗进展[J].中国妇产科临床杂志,2007,8(1)：3-4.
[3]Abrams P, Blaivas JG, Stanton SL, et al. The standardization of terminology of lower urinary tract function recommended by the international continence society[J]. Int Urogynecol,1990,1:453-465.
[4]王建六.女性盆底功能障碍性疾病研究进展[J].中国医刊,2005,40(8)：10-11.
[5]田建平.女性盆底功能障碍性疾病研究进展[J].河北医药,2007,29(2)：163-164.
[6]王玉珍,杨萍,梁志清.盆底器官脱垂及其病因学研究进展[J].西北国防医学杂志,2006,27(3)：219-218.
[7]MillerKL. Stress urinary incontinence in women:reviewand update on neurological control[J]. JWomensHealth(Larchmt),2005,14:595-608.
[8]Delancey JO.The hidden epidemic ofpelvic floordysfunction:achievable goals for improved prevention and treatment[J].Am JObstetGyneco,l 2005,192:1488-1495
[9]Eftekhar T,Hajibaratali B, Ramezanzadeh F, et a.l Postpartum evaluation of stress urinary incontinence amongprimiparas[J]. Int JGynecolObstet,2006,94:114-118
[10]Bergman A, EliaG, cheung D,et al.Biochemical composition of collagen in continent and stress urinary incontinentwomen[J].GynecolObstetInvest,1994,37 (1): 48.
[11]孙智晶,朱兰,郎景和.压力性尿失禁的病因学研究进展[J].现代妇产科学进展,2001,10(1)：63-64.
[12]Bai SW, JeonMJ,Kim JY,et al.Relationship between stressurinary incontinence and pelvic organ prolapse[J]. IntUrogynecol J Pelvic FloorDysfunct,2002,13(4): 256-260.
[13]Dwyer PL.Female pelvic floordysfunction and estrogen therapy [J]. Climacteric, 2001,4(3):179.
[14]Parazzini F,Colli E,Origgi G,et al.Risk factors for urinary incontinence in women.Eur Urol,2000,37(6);637-643.
[15]Newman DK.Conservative management of urinary incontinence in women[J]. PrimCare Update Obste Gynecol,2001,8(4):153-162.
[16]Shawn AM,Ralph C,Lewis LW.Stress urinary incontinence due to prescription medications:alpha-blockers and angiotensin converting enzyme inhibitors[J].Obster Gynecol,1998,91(5):853-854
[17]Bump RS,McClish DM.Cigarette smoking and pure genuine stress incontinence of urine:a comparison of risk factors and determinants between smokers and nonsmokers[J].Am J Obstet Gynecol,1994,170(2):579-582.
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[19]黄晓军,张晓薇,赵群等.女性压力性尿失禁发生的相关因素分析[J].中国妇幼保健2005,20(11)：1404-1406.
[20]Mason L,Glenn S,Walton L et al.The instruction in pelvic floor exercises procided to women during pregnancy or following delivery[J].Midwifery,2001,17(1):55-64.
[21]King JK, Freeman RM. Is antenatal bladder neck mobility a risk factor for postpa-rtum stress incontinence[J]. Br J Obstet GynAecol,1998,105:1300-1307.
[22]Sultan AH, Kamm MA, Hudson CN. Pudendal nerve damage during labour:pro-spective study before and after childbirth[J]. Br J Obstet Gynecol,1994,101(1): 22-28.
[23]Gregory WT, Lou JS, StuyvesantA, et al. Quantitative electro-myography of the anal sphincter after uncomplicated vaginal delivery [J]. Obstet Gynecol,2004, 104(2):327-335.
[24]Hojberg KE, Salvig JD, Winslow NA, et al. Urinary incontinence:prevalence and risk factors at 16 weeks of gestation[J]. Br J Obstet Gynaecol,1999,106: 842-850.
[25]Estrogen/Progestin Replacement Srudy(HERS)Research Group.Prevalence of urinary incontinence and associated risk factors in postmenopausal women[J]. Obstet Gynecol,1999,94(1):66-70.
[26]Chiarelli P,Brown WJ.Leaking urine in Australian women:prevalence and associated conditions[J]. Women Health,1999,29(1):1-13.
[27]Goldberg RP, Kwon C, Gandhi S,et al.Urinanry incontinence among mothers ofmultiples:the protective effect of cesarean delivery [J]. Am J ObstetGyneco,l 2003, 188 (6):1447～1453.
[28]RortveitG, DaltveitAK, Hannestad YS,et al.Urinary incontinence after vaginal delivery or cesarean section[J].N Engl JMed,2003,348 (10):900～907.
[29]Goldberg RP, Kwon C, Gandhi S,et al.Urinanry incontinence among mothers ofmultiples:the protective effect of cesarean delivery [J]. Am J ObstetGyneco,l 2003, 188 (6):1447～1453.
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[2]杨欣,王建六.盆腔脏器脱垂的治疗进展[J].中国妇产科临床杂志,2007,8(1)：3-4.
[3]Abrams P, Blaivas JG, Stanton SL, et al. The standardization of terminology of lower urinary tract function recommended by the international continence society[J]. Int Urogynecol,1990,1:453-465.
[4]王建六.女性盆底功能障碍性疾病研究进展[J].中国医刊,2005,40(8)：10-11.
[5]田建平.女性盆底功能障碍性疾病研究进展[J].河北医药,2007,29(2)：163-164.
[6]王玉珍,杨萍,梁志清.盆底器官脱垂及其病因学研究进展[J].西北国防医学杂志,2006,27(3)：219-218.
[7]MillerKL. Stress urinary incontinence in women:reviewand update on neurological control[J]. JWomensHealth(Larchmt),2005,14:595-608.
[8]Delancey JO.The hidden epidemic ofpelvic floordysfunction:achievable goals for improved prevention and treatment[J].Am JObstetGyneco,l 2005,192:1488-1495
[9]Eftekhar T,Hajibaratali B, Ramezanzadeh F, et a.l Postpartum evaluation of stress urinary incontinence amongprimiparas[J]. Int JGynecolObstet,2006,94:114-118
[10]Bergman A, EliaG, cheung D,et al.Biochemical composition of collagen in continent and stress urinary incontinentwomen[J].GynecolObstetInvest,1994,37 (1): 48.
[11]孙智晶,朱兰,郎景和.压力性尿失禁的病因学研究进展[J].现代妇产科学进展,2001,10(1)：63-64.
[12]Bai SW, JeonMJ,Kim JY,et al.Relationship between stressurinary incontinence and pelvic organ prolapse[J]. IntUrogynecol J Pelvic FloorDysfunct,2002,13(4): 256-260.
[13]Dwyer PL.Female pelvic floordysfunction and estrogen therapy [J]. Climacteric, 2001,4(3):179.
[14]Parazzini F,Colli E,Origgi G,et al.Risk factors for urinary incontinence in women.Eur Urol,2000,37(6);637-643.
[15]Newman DK.Conservative management of urinary incontinence in women[J]. PrimCare Update Obste Gynecol,2001,8(4):153-162.
[16]Shawn AM,Ralph C,Lewis LW.Stress urinary incontinence due to prescription medications:alpha-blockers and angiotensin converting enzyme inhibitors[J].Obster Gynecol,1998,91(5):853-854
[17]Bump RS,McClish DM.Cigarette smoking and pure genuine stress incontinence of urine:a comparison of risk factors and determinants between smokers and nonsmokers[J].Am J Obstet Gynecol,1994,170(2):579-582.
[18]宋岩峰,林坚,李亚钦等.女性压力性尿失禁发生的危险因素分析[J].中华妇产科杂志,2003,38(12)：737-740.
[19]黄晓军,张晓薇,赵群等.女性压力性尿失禁发生的相关因素分析[J].中国妇幼保健2005,20(11)：1404-1406.
[20]Mason L,Glenn S,Walton L et al.The instruction in pelvic floor exercises procided to women during pregnancy or following delivery[J].Midwifery,2001,17(1):55-64.
[21]King JK, Freeman RM. Is antenatal bladder neck mobility a risk factor for postpa-rtum stress incontinence[J]. Br J Obstet GynAecol,1998,105:1300-1307.
[22]Sultan AH, Kamm MA, Hudson CN. Pudendal nerve damage during labour:pro-spective study before and after childbirth[J]. Br J Obstet Gynecol,1994,101(1): 22-28.
[23]Gregory WT, Lou JS, StuyvesantA, et al. Quantitative electro-myography of the anal sphincter after uncomplicated vaginal delivery [J]. Obstet Gynecol,2004, 104(2):327-335.
[24]Hojberg KE, Salvig JD, Winslow NA, et al. Urinary incontinence:prevalence and risk factors at 16 weeks of gestation[J]. Br J Obstet Gynaecol,1999,106: 842-850.
[25]Estrogen/Progestin Replacement Srudy(HERS)Research Group.Prevalence of urinary incontinence and associated risk factors in postmenopausal women[J]. Obstet Gynecol,1999,94(1):66-70.
[26]Chiarelli P,Brown WJ.Leaking urine in Australian women:prevalence and associated conditions[J]. Women Health,1999,29(1):1-13.
[27]Goldberg RP, Kwon C, Gandhi S,et al.Urinanry incontinence among mothers ofmultiples:the protective effect of cesarean delivery [J]. Am J ObstetGyneco,l 2003, 188 (6):1447～1453.
[28]RortveitG, DaltveitAK, Hannestad YS,et al.Urinary incontinence after vaginal delivery or cesarean section[J].N Engl JMed,2003,348 (10):900～907.
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