阴式子宫切除加阴道前后壁修补术对器官脱垂患者近期盆底功能的影响

目的探讨阴式子宫切除加阴道前后壁修补术对子宫脱垂伴阴道前壁或后壁脱垂患者盆底功能的近期影响。方法选择2010年1月至2011年5月于广州医科大学附属第三医院因子宫脱垂伴阴道前壁或后壁脱垂行阴式子宫切除加阴道前后壁修补术治疗的49例患者为研究对象,于术前、术后两年行妇科检查及相关问卷调查,从阴道壁脱垂、大小便情况、性生活及盆底肌力等方面评价经阴式子宫切除加阴道前后壁修补术对这些患者近期盆底功能的影响。结果 49例患者中术后两年阴道前壁或后壁脱垂例数较术前明显减少(P0.05);术后两年尿失禁问卷简表评分为(3.5±0.5)分,术前评分为(6.5±0.8)分,差异有统计学意义(P0.05);术后两年尿垫试验阳性率为14.29%,术前阳性率为57.14%(P0.05);术后两年有尿失禁或便秘、大便次数增多、大便时下坠感患者较术前明显减少,差异有统计学意义(P0.05)。术后有性生活患者性生活质量不满意。术前、术后两年的盆底肌张力及收缩力无明显变化,差异无统计学意义(P0.05)。结论阴式子宫切除加阴道前后壁修补术对盆腔器官脱垂患者短期内疗效显著,近期盆底功能影响尚小。

Research on the short-term effects of pelvic floor function for patients after vaginal hysterectomy with vaginal anterior and posterior wall repair

Objective To evaluate the short-term status of female pelvic floor function after vaginal hysterectomy with vaginal anterior and posterior wall repair. Methods 49 patients undergoing vaginal hysterectomy with vaginal anterior and posterior wall repair surgery due to pelvic organ prolapse and vaginal anterior or posterior wall prolapse between January 2010 and May 2007 were recalled to the hospital and participate in the follow-up study after two years. Gynecological examination and relevant questionnaire were done before and after surgery, including vaginal wall prolapse, urination and defecation, sexual life and pelvic floor muscle strength, in order to evaluate the short-term effects of pelvic floor function for patients after vaginal hysterectomy with vaginal anterior and posterior wall repair. Results The cases of vaginal anterior or posterior wall prolapse after postoperative two years decreased significantly compared with those cases in pre-operation （P〈0.05）. The mean score of international incontinence questionnaire summary table （ICI-Q-SF）changes from （6.5±0.8） in pre-operation to （3.5±0.4） in postoperative two years（P〈0.05）. Positive rate of urine pad test changes from 57.14% in pre-operation to 14.29% in postoperative two years （P〈0.05）. Those cases with urinary incontinence, constipation,fecal frequency and feeling of bearing clown with defecate in postoperative two years were reduced significantly than pre-operation（P〈0.05 ）. Patients with sexual life after surgery reflect unsatisfactory sexual life. There is no significant change in pelvic floor muscle tension and contraction force after postoperative two years compared to pre- operation （P〉0.05）. Conclusion Vaginal hysterectomy with vaginal anterior and posterior wall is effective to patients with pelvic organ prolapse in a short time, which has little short-term effects to pelvic floor function.