北京协和医院健康体检妇女盆腔器官脱垂程度及其危险因素分析

目的 研究北京协和医院常规体检妇女的盆腔器官脱垂(POP)情况及其临床特征,探讨其发病相关因素.方法 对2008年1月-2009年8月在本院行常规健康体检的972名成年妇女进行现场问卷调查以及妇科检杳,由专人采用POP定量分度(POP-Q)法九格表进行测量,并记录各项指标的测量值.结果 (1)观察对象的平均年龄为(42±10)岁(22～78岁),平均身高(162±5)cm(142～180 cm),平均体质量(59±8)kg(42～91 kg);83.8%(815/972)为已分娩妇女.972名妇女的平均阴道长度(TVL)为(8.20±0.35)cm.所有观察对象均未达到POP的诊断标准,其中35.5%(345/972)存在阴道后壁轻度膨出,96.7%(940/972)存在阴道前壁轻度膨出,但均无自觉症状.(2)972名妇女中,未分娩者的生殖道缝隙(gh)、TVL测量值及C、D点距处女膜缘的罡巨离分别为(2.26±0.32)、(8.08±0.30)、(-7.08±0.24)和(-8.08±0.30)cm,均小于已分娩者[分别为(2.33±0.39)、(8.22 ±0.35)、(-7.14±0.28)和(-8.22±0.35)cm],Ap、Bp点距处女膜缘的距离分别为(-2.87±0.22)、(-2.87±0.22)cm,均大于已分娩者[分别为(-2.81±0.25)、(-2.81±0.25)cm],以上各项两者间比较,差异均有统计学意义(P<0.05).与未分娩妇女比较,已分娩妇女阴道后壁膨出的风险增加(OR=1.819).(3)22～34岁、35～49岁及≥50岁者的POP-Q各项指标测量值比较,差异均有统计学意义(P<0.05);22～34岁者与35～49岁者之间比较,差异无统计学意义(P>0.05);22～34岁、35～49岁者分别与≥150岁者比较,差异均有统计学意义(P<0.05).与22～34岁者比较,35～49岁及≥50岁者发生阴道后壁膨出的风险增高(OR=1.713、3.765).(4)绝经后妇女的POP-Q各项指标测馈值均小于未绝经妇女,差异也均有统计学意义(P<0.05);与未绝经妇女比较,绝经后妇女阴道后壁膨出的风险增加(OR=3.354).结论 在我国健康体检的成年妇女中,以POP-Q法作为评价POP程度的指标时,轻度的阴道前、后壁膨出很常见,阴道前壁膨出较后壁膨出的检出率高,但通常并无症状,临床上不需干预.分娩史和年龄是影响阴道壁膨出严重程度及检出率的重要危险因素.

Analysis of prevalence and risk factors of pelvic organ prolapse of women underwent gynecologic health care in Peking Union Medical College Hospital

Objective To investigate prevalence and risk factors of pelvic organ prolapse in women underwent routine gynecologic health care in Peking Union Medical College Hospital (PUMCH).Methods From Jan.2008 to Aug.2009,972 women underwent gynecological health care in PUMCH Were enrolled in this study.Questionnaires and pelfic examinations were given.The pelvic organ prolapse quantitive examination(POP-Q)system was used as the assessment tool.Results (1)Among all participants,the mean ages were(42±10)years(range 22 to 78 years),the mean height were(162±5)cm(range 142 to 180 cm),and the mean weight were(59±8)kg(range 42 to 91 kg).83.8%(815/972)of women were multipara.The mean total vagihal length(TVL)of 972 women was 8.20 cm.No women met the standard of pelvic organ prolapse, while 35.5% (345/972) of women presented mild posterior vaginal descent and 96. 7% (940/972) presented mild anterior vaginal descent, all of them were asymptomatic. (2) The length of genital hiatus (gh), TVL and C, D proximal to the hymen in nullipara were (2.26 ±0. 32), (8.08 ±0. 30), ( - 7.08 ± 0. 24) and ( - 8. 08 ± 0. 30) cm, which were significantly less than ( 2. 33 ± 0. 39 ),( 8. 22 ± 0. 35 ), ( - 7. 14 ± 0. 28 ) and ( - 8. 22 ± 0. 35 ) cm in multipara ( P < 0. 05 ). Ap and Pb proximal to the hymen of ( - 2. 87 ± 0. 22) and ( - 2. 87 ± 0. 22 ) cm in nullipara were significantly larger than ( -2.81 ±0.25) and ( -2.81 ±0.25) cm in multipara (P<0.05). When compared with nullipara, the incidence of posterior and anterior vaginal wall protrusion were increased ( OR = 1. 819). (3) The index of POP-P were compared among women at groups of 22 -34 years, 35 -49 years and more than 50 years (P <0. 05 ). Those index did not show statistical difference between women at group of 22 - 34 years and group of 35 -49 years (P >0. 05). However, those in women at group of 22 -34 years and 35 -49 years showed statistical difference when compared with women at group of more than 50 years ( P < 0. 05 ). When compared with women at group of 22 - 34 years, the incidence of posterior and anterior vaginal wall protrusion were increased ( OR = 1. 713, 3. 765). (4) Menopause status was associated with severities of all kinds of descent ( P < 0. 05 ) and presence of posterior vaginal protrusion ( OR = 3. 354 ). Conclusions Mild anterior and posterior vaginal descent by POP-Q were common among women in China. The risk of anterior vaginal descent is relatively higher than posterior vaginal descent. However, most of the women with descent are asymptomatic and need no treatment. The most important factors associated with the severity and detectable ratio of descent is parity and age.