盆腔器官脱垂及压力性尿失禁的相关因素分析
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摘要
目的:探讨盆腔器官脱垂及压力性尿失禁的相关危险因素。方法:选择2007年1月至2016年1月在郑州大学第三附属医院盆底重建科行盆底重建术患者625例,将其中盆腔器官脱垂患者454例为A组,压力性尿失禁患者171例为B组,另选择体检的健康女性449例为对照组。分别统计分析其孕产次,是否绝经,有无子宫切除、慢性高血压、糖尿病、会阴裂伤、子宫肌瘤及阴道分泌物分析结果等资料,并进行单因素和多因素Logistic回归分析。结果:单因素分析示:A组子宫切除、已绝经、会阴裂伤患者所占比例均明显高于对照组(P<0.05);B组慢性高血压、会阴裂伤的患者所占比例均明显高于对照组(P<0.05);A组、B组多孕次(≥3次)、多产次(≥3次)患者所占比例高于对照组(P<0.05),存在乳杆菌患者所占比例低于对照组(P<0.05)。多因素Logistic回归分析示:子宫切除、已绝经、会阴裂伤、孕次≥3次、产次≥3次是盆腔器官脱垂的独立危险因素;会阴裂伤、孕次≥3次、产次≥3次是压力性尿失禁的独立危险因素。存在乳杆菌是盆底器官脱垂和压力性尿失禁的保护因素。结论:子宫切除、多孕、多产、会阴裂伤可能参与了盆腔器官脱垂及压力性尿失禁的发生发展,阴道乳杆菌的存在可能减少盆腔器官脱垂及压力性尿失禁的发生。
Objective: To explore the risk factors of pelvic organ prolapse and stress urinary incontinence factors.Methods: A total of 625 patients,who undergone surgery for pelvic floor reconstuction from January 2007 to January2016 in the Third Affiliated Hospital of Zhengzhou University,were enrol ed for this study.Among which 454 cases of pelvic organ prolapse were assigned as group A,and 171 cases of stress urinary incontinence were assigned as group B.Meanwhile,449 female healthy subjects were selected as control group.The data including the times of gestation and parity,history of menopause,hysterectomy surgery,chronic hypertension,diabetes mel itus,history of perineal laceration,uterine fibroid and leucorrhea were recorded and analyzed by single factor analysis and multi-factor Logistic repression analysis.Results: Single factor analysis showed that the proportion of patients in group A who had the history of hysterectomy,menopause and perineal lacerationwas significantly higher than the control group( P<0. 05).The proportion of patients in group B who had the history of menopausal,hypertension,perineal laceration was significantly higher than the control group( P<0. 05).The proportion of patients in goup A and B who had the existence of lactobacil us,more times of gestation and paritywere significantly higher than the control group( P < 0. 05). Multi-factors analysis showed that the history of hysterectomy,menopause,perineal laceration,gravidity idity,parity are independent risk factors for pelvic organ prolapse; perineal laceration,gravidity,parity are independent risk factors for stress urinary incontinence.The existence of lactobacil us in the vagina is a protective factors for stress urinary incontinence and pelvic organ prolapse.Conclusions: The history of hysterectomy,more times of gestation and parity,perineal laceration and lack of lactobacil us may be involved in the development of pelvic organ prolapse and stress urinary incontinence.The existence of lactobacil us in the vagina is a protective factor.
Objective: To explore the risk factors of pelvic organ prolapse and stress urinary incontinence factors.Methods: A total of 625 patients,who undergone surgery for pelvic floor reconstuction from January 2007 to January2016 in the Third Affiliated Hospital of Zhengzhou University,were enrol ed for this study.Among which 454 cases of pelvic organ prolapse were assigned as group A,and 171 cases of stress urinary incontinence were assigned as group B.Meanwhile,449 female healthy subjects were selected as control group.The data including the times of gestation and parity,history of menopause,hysterectomy surgery,chronic hypertension,diabetes mel itus,history of perineal laceration,uterine fibroid and leucorrhea were recorded and analyzed by single factor analysis and multi-factor Logistic repression analysis.Results: Single factor analysis showed that the proportion of patients in group A who had the history of hysterectomy,menopause and perineal lacerationwas significantly higher than the control group( P<0. 05).The proportion of patients in group B who had the history of menopausal,hypertension,perineal laceration was significantly higher than the control group( P<0. 05).The proportion of patients in goup A and B who had the existence of lactobacil us,more times of gestation and paritywere significantly higher than the control group( P < 0. 05). Multi-factors analysis showed that the history of hysterectomy,menopause,perineal laceration,gravidity idity,parity are independent risk factors for pelvic organ prolapse; perineal laceration,gravidity,parity are independent risk factors for stress urinary incontinence.The existence of lactobacil us in the vagina is a protective factors for stress urinary incontinence and pelvic organ prolapse.Conclusions: The history of hysterectomy,more times of gestation and parity,perineal laceration and lack of lactobacil us may be involved in the development of pelvic organ prolapse and stress urinary incontinence.The existence of lactobacil us in the vagina is a protective factor.
引文
[1]朱兰,郎景和,刘春燕,等.我国成年女性尿失禁患病状况的流行病学研究[J].中华妇产科杂志,2009,44(7):776-779.
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[8]Reigota RB,Pedro AO,De SSMV,et al.Prevalence of urinary incontinence and its association with multimorbidity in women aged 50 years or older:A population-based study[J].Neurourol Urody,2016,35(1):62-68.
[9]Hall R,Kkhalsa S,Qualls C,et al.Acomparison of periurethral blood flow resistive indices and urethral closure pressure of incontinent women[J].Int Urogynecol J Pelvic Floor Dysfunct,2006,17(5):472-477.
[10]中华医学会妇产科学分会感染性疾病协作组.阴道微生态评价的临床应用专家共识[J].中华妇产科杂志,2016,51(10):721-723.
[11]Brizzolara S,Killeen J,Urschitz J.Gene expression profile in pelvic organ prolapse[J].Moleculr Human Reprod,2009,15(1):59-67.
[12]Chen B,Wen Y,Yu X.The role of neutrophil elastase in elastin metabolism of pelvic issues from women with stress urinary incontinence[J].Neurourol Urodyn,2007,26(2):274-279.
[13]Zhao B,Yan J,Huiyan WU,et al.Interferon-!and its pathway associated gene expression in the vaginal tissue of premenopausal females with pelvic organ prolapse[J].Experiment Therapeut Med,2014,8(4):1145-1149.
[14]Capobianco G,Wenger JM,Meloni GB,et al.Triple therapy with Lactobacilli acidophili,estriol plus pelvic floor rehabilitation for symptoms of urogenital aging in postmenopausal women[J].Arch Gynecol Obstet,2014,289(3):601-608.
[2]韩洁,方凡夫,俞超芹,等.老年妇女常见妇科疾病的预防与保健[J].中华保健医学杂志,2008,10(4):316-317.
[3]Zeleke BM,Bell RJ,Billah B,et al.Symptomatic pelvic floor disorders in community-dwelling older Australian women[J].Maturitas,2016,85(1):34-41.
[4]Rortveit G,Brown JS,Thom DH,et al.Symptomatic pelvic organ prolapse:Prevalence and risk factors in a population-based,racially diverse cohort[J].Obstet Gynecol,2007,109(6):1396-1403.
[5]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.
[6]Leroy LS,Lúcio A,Lopes MHBM.Risk factors for postpartum urinary incontinence[J].Rev Esc Enferm USP,2016,50(2):200-207.
[7]Liu B,Wang L,Huang SS,et al.Prevalence and risk factors of urinary incontinence among Chinese women in Shanghai[J].Int J Clin Exp Med,2014,7(3):686-696.
[8]Reigota RB,Pedro AO,De SSMV,et al.Prevalence of urinary incontinence and its association with multimorbidity in women aged 50 years or older:A population-based study[J].Neurourol Urody,2016,35(1):62-68.
[9]Hall R,Kkhalsa S,Qualls C,et al.Acomparison of periurethral blood flow resistive indices and urethral closure pressure of incontinent women[J].Int Urogynecol J Pelvic Floor Dysfunct,2006,17(5):472-477.
[10]中华医学会妇产科学分会感染性疾病协作组.阴道微生态评价的临床应用专家共识[J].中华妇产科杂志,2016,51(10):721-723.
[11]Brizzolara S,Killeen J,Urschitz J.Gene expression profile in pelvic organ prolapse[J].Moleculr Human Reprod,2009,15(1):59-67.
[12]Chen B,Wen Y,Yu X.The role of neutrophil elastase in elastin metabolism of pelvic issues from women with stress urinary incontinence[J].Neurourol Urodyn,2007,26(2):274-279.
[13]Zhao B,Yan J,Huiyan WU,et al.Interferon-!and its pathway associated gene expression in the vaginal tissue of premenopausal females with pelvic organ prolapse[J].Experiment Therapeut Med,2014,8(4):1145-1149.
[14]Capobianco G,Wenger JM,Meloni GB,et al.Triple therapy with Lactobacilli acidophili,estriol plus pelvic floor rehabilitation for symptoms of urogenital aging in postmenopausal women[J].Arch Gynecol Obstet,2014,289(3):601-608.