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山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (12): 39-43.doi: 10.6040/j.issn.1671-7554.0.2022.0741

• • 上一篇    

重度盆腔器官脱垂患者治疗选择及影响因素

靳鲁珺1,林雪艳1,刘天航1,李青2,李晓文2,房蕾1,孙浩1,田永杰1,2   

  1. 1.山东第一医科大学附属省立医院妇科, 山东 济南 250021;2.山东大学齐鲁医学院, 山东 济南 250012
  • 发布日期:2022-12-01
  • 通讯作者: 田永杰. E-mail:tianyongjie@sdu.edu.cn
  • 基金资助:
    中华预防医学会科研资金支持项目(201815072)

Influencing factors of the choice of treatment for patients with severe pelvic organ prolapse

JIN Lujun1, LIN Xueyan1, LIU Tianhang1, LI Qing2, LI Xiaowen2, FANG Lei1, SUN Hao1, TIAN Yongjie1,2   

  1. 1. Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China;
    2. Cheello College of Medicine, Shandong University, Jinan 250012, Shandong, China
  • Published:2022-12-01

摘要: 目的 探讨影响重度盆腔器官脱垂患者选择治疗方式的相关因素。 方法 选取2020年12月至2022年3月期间因重度盆腔器官脱垂就诊的患者为研究对象(n=145),根据患者意愿分为手术组(n=78)和子宫托组(n=67)。比较两组一般临床资料、自我身体形象评价量表(MBIS)评分及盆底障碍量表简表(PFDI-20)评分,采用单因素分析和二分类Logistic回归分析探讨影响重度盆腔器官脱垂患者选择治疗方式的相关因素。 结果 手术组与子宫托组比较,体质量指数(BMI)、就诊年龄、患病年限、中盆腔器官脱垂定量分期、合并症、MBIS评分及泌尿生殖影响量表简表(UDI-6)评分差异均有统计学意义(P<0.001,P=0.036,P<0.001,P<0.001,P=0.005,P<0.001,P<0.001)。Logistic回归多因素分析显示,就诊年龄、患病年限、中盆腔器官脱垂定量分期、合并多种内科疾病、MBIS评分及UDI-6评分为重度盆腔器官脱垂患者选择不同治疗方式的独立影响因素(P=0.006,P=0.005,P=0.019,P=0.009,P=0.001,P=0.023)。 结论 就诊年龄较大、患病年限较长、中盆腔器官脱垂分期较高、自我身体形象评价较低以及下尿路症状明显的患者更倾向于选择手术治疗,而合并多种内科疾病的患者通常选择子宫托治疗。

关键词: 重度盆腔器官脱垂, 手术治疗, 子宫托治疗, 相关因素

Abstract: Objective To explore factors influencing the selection of treatment strategy for patients with severe pelvic organ prolapse(POP). Methods A total of 145 patients with severe POP treated during Dec. 2020 and Mar. 2022 were selected and divided into the surgical group(n=78)and pessary group(n=67)according to the treatment strategy. The general information, scores of the modified body self-image scale(MBIS), scores of pelvic floor distress inventory short form(PFDI-20), and scores of urogenital distress inventory short form(UDI-6)were compared between the two groups. Factors influencing the selection of treatment strategies were analyzed with univariate and binary Logistic regression analyses. Results Statistically significant differences were found in body mass index(BMI), age of initial visit, course of illness, mid-pelvic POP-Q stage, complications, MBIS scores and UDI-6 scores between the two groups(P<0.001, P=0.036, P<0.001, P<0.001, P=0.005, P<0.001, P<0.001). Logistic regression showed that age of initial visit, course of illness, mid-pelvic POP-Q stage, complications, MBIS scores and UDI-6 scores were independent factors influencing the choice of different treatment modalities(P=0.006, P=0.005, P=0.019, P=0.009, P=0.001, P=0.023). Conclusion Patients who visit the clinic at an older age, have a long course of disease, severer mid-pelvic POP-Q stage, lower MBIS scores and lower urinary tract symptoms are more likely to choose surgery, while patients complicated with other diseases like to choose pessary.

Key words: Severe pelvic organ prolapse, Surgical treatment, Pessary treatment, Influencing factors

中图分类号: 

  • R711.2
[1] 颉红杰, 邓欣, 双卫兵. 女性盆腔脏器脱垂的影响因素[J]. 泌尿外科杂志(电子版), 2020, 12(2): 7-11. XIE Hongjie, DENG Xin, SHUANG Weibin. Influencing factors of female pelvic organ prolapse [J]. Journal of Urology for Clinicians(ElectronicVersion), 2020, 12(2): 7-11.
[2] Costantini E, Mearini L, Lazzeri M, et al. Laparoscopic Versus abdominal sacrocolpopexy: a randomized, controlled trial [J]. J Urol, 2016, 196(1): 159-165.
[3] 张桓, 朱兰, 徐涛, 等. 简化POP-Q分度系统与标准POP-Q分度法用于盆腔器官脱垂的对比研究[J]. 中华妇产科杂志, 2016, 51(7): 510-514. ZHANG Huan, ZHU Lan, XU Tao, et al. Utilize the simplified POP-Q system in the clinical practice of staging for pelvic organ prolapse: comparative analysis with standard POP-Q system [J]. Chinese Journal of Obstetrics and Gynecology, 2016, 51(7): 510-514.
[4] 张迎辉, 鲁永鲜. 盆底功能障碍研究中的调查问卷[J]. 中华妇产科杂志, 2009, 44(12): 956-959.
[5] 王晓茜. 改良女性自我形象评价量表(MBIS)、尿失禁生活质量问卷(I-QOL)、子宫肌瘤症状及健康相关生活质量问卷(UFS-QOL)中文版本研制与中国人群验证[D]. 北京: 北京协和医学院, 2013.
[6] Raju R, Linder B. Evaluation and management of Pelvic organ prolapse [J]. Mayo Clin Proc, 2021, 96(12): 3122-3129.
[7] 李春波, 舒慧敏, 戴志远. 腹腔镜下腹股沟韧带悬吊术治疗中重度盆腔器官脱垂的疗效分析[J]. 实用妇产科杂志, 2019, 35(6): 435-439. LI Chunbo, SHU Huimin, DAI Zhiyuan. The effect analysis of laparoscopic inguinal ligament suspension for the re- pair of mild and severe pelvic organ Prolapse [J]. Journal of Practical Obsterics and Gynecology, 2019, 35(6): 435-439.
[8] ACOG Committee on Practice Bulletins - Gynecology. ACOG Practice Bulletin No. 85: Pelvic organ prolapse [J]. Obstet Gynecol, 2007, 110(3): 717-729.
[9] Miceli A, Dueñas-Diez JL. Effectiveness of ring pessaries versus vaginal hysterectomy for advanced pelvic organ prolapse. A cohort study [J]. Int Urogynecol J, 2019, 30(12): 2161-2169.
[10] Lamers BH, Broekman BM, Milani AL. Pessary treatment for pelvic organ prolapse and health-related quality of life: a review [J]. Int Urogynecol J, 2011, 22(6): 637-644.
[11] Zeiger BB, da Silva Carramão S, Del Roy CA, et al. Vaginal pessary in advanced pelvic organ prolapse: impact on quality of life [J]. Int Urogynecol J, 2022, 33(7): 2013-2020.
[12] 王红梅. 重度盆腔器官脱垂患者治疗方案选择的影响因素[J]. 医学临床研究, 2016, 33(6): 1198-1200.
[13] de Boer T, Slieker-Ten Hove M, Burger C, et al. The prevalence and factors associated with previous surgery for pelvic organ prolapse and/or urinary incontinence in a cross-sectional study in The Netherlands [J]. Eur J Obstet Gynecol Reprod Biol, 2011, 158(2): 343-349.
[14] 赵英, 鲁永鲜, 王文英. 重度盆腔器官脱垂患者治疗方案选择的相关因素分析[J]. 中国妇幼健康研究, 2016, 27(3): 354-356. ZHAO Ying, LU Yongxian, WANG Wenying. Related fctors of selecting treatment options for severe pelvic organ prolapse [J]. Chinese Journal of Woman and Child Health Research, 2016, 27(3): 354-356.
[15] 赖海清. 重度盆腔器官脱垂患者选择手术治疗或子宫托治疗的影响因素分析[J]. 中国妇幼保健, 2020, 35(4): 600-603. LAI Haiqing. Patients with severe pelvic organ prolapse choose surgical treatment or uterine bracket treatment influence factor [J]. Maternal and Child Health Care of China, 2020, 35(4): 600-603.
[16] Bugge C, Adams E, Gopinath D, et al. Pessaries(mechanical devices)for managing pelvic organ prolapse in women [J]. Cochrane Database Syst Rev, 2020, 11: CD004010. doi:10.1002/14651858.
[17] Friedman W, Gallup D, Burke J, et al. Outcomes of octogenarians and nonagenarians in elective major gynecologic surgery [J]. Am J Obstet Gynecol, 2006, 195(2): 547-552.
[18] Mendes LC, Bezerra L, Bilhar APM, et al. Symptomatic and anatomic improvement of pelvic organ prolapse in vaginal pessary users [J]. Int Urogynecol J, 2021, 32(4): 1023-1029.
[19] Hammad FT, Elbiss HM, Osman N. The degree of bother and healthcare seeking behaviour in women with symptoms of pelvic organ prolapse from a developing gulf country [J]. BMC Womens Health, 2018, 18(1): 77. doi:10.1186/s12905-018-0570-8.
[20] Basu M, Wise B, Duckett J. A qualitative study of women's preferences for treatment of pelvic floor disorders [J]. Bjog, 2011, 118(3): 338-344.
[21] Coolen AWM, Troost S, Mol BWJ, et al. Primary treatment of pelvic organ prolapse: pessary use versus prolapse surgery [J]. Int Urogynecol J, 2018, 29(1): 99-107.
[22] 徐婉婉, 赵小峰. 治疗中盆腔缺陷的盆底修复手术方式研究进展 [J]. 浙江医学, 2021, 43(6): 687-690.
[23] Viljoen M. Body image: a handbook of theory, research, and clinical practice [J]. Educ Health, 2003, 16(2): 243-245.
[24] Hopwood P, Fletcher I, Lee A, et al. A body image scale for use with cancer patients [J]. Eur J Cancer, 2001, 37(2): 189-197.
[25] Ninivaggio CS, Komesu YM, Jeppson PC, et al. Perineorrhaphy outcomes related to body imagery: a randomized trial of body image perception [J]. Female Pelvic Med Reconstr Surg, 2021, 27(5): 281-288.
[26] Rogers RG, Meyer I, Smith AL, et al. Improved body image after uterovaginal prolapse surgery with or without hysterectomy [J]. Int Urogynecol J, 2022, 33(1): 115-122.
[27] Lowder JL, Ghetti C, Nikolajski C, et al. Body image perceptions in women with pelvic organ prolapse: a qualitative study [J]. Am J Obstet Gynecol, 2011, 204(5): 441.e1-5.
[28] Handelzalts JE, Yaakobi T, Levy S, et al. The impact of genital self-image on sexual function in women with pelvic floor disorders [J]. Eur J Obstet Gynecol Reprod Biol, 2017, 211: 164-168. doi:10.1016/j.ejogrb.2017.02.028.
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