非脱垂全子宫切除术后尿失禁发病率及危险因素——7年回顾性队列研究

发布时间：2018-01-20 05:07

本文关键词： 全子宫切除术尿失禁患病率危险因素　出处：《现代妇产科进展》2015年01期 　论文类型：期刊论文

【摘要】：目的:观察因非脱垂良性疾病行全子宫切除术对患者泌尿功能的长期影响,并探讨术后尿失禁(UI)的发生率及其危险因素。方法:选取2003年1月至2013年1月在北京协和医院因非子宫脱垂良性疾病(术前均无UI及脱垂,术后病理结果证实)行全子宫切除术或非子宫切除术者共560例,其中行全子宫切除术者384例,非子宫切除术者176例(对照组)。分别进行电话问卷随访,通过中文验证版女性下尿路症状国际尿失禁标准问卷(ICIQ-FLUTS)及尿道疾病程度分类问卷(UDI-6)完成术前、术后1年、3年、5年、7年的主观泌尿功能评价调查,观察术前无脱垂或尿失禁患者术后尿失禁的患病情况。结果:264例患者有效完成问卷,其中全子宫切术组164例(62.1%),对照组100例(37.9%)。术后1年时,全子宫切除术组的UI患病率显著高于对照组(P=0.031),而长期随访发现两者并无显著差异(P0.05)。术后1年、3年、5年和7年,全子宫切除组患者的UI患病率分别为8.5%(14/164)、9.7%(10/103)、12.2%(10/82)和16.7%(10/60)。全子宫切术组的压力性尿失禁(SUI)、急迫性尿失禁(UUI)等症状的术后患病率均明显高于对照组;急迫性尿失禁较压力性尿失禁常见。多因素分析发现,多产为UI发生的独立危险因素(OR=3.87,95%CI为1.12~13.33)。结论:全子宫切除术增加术后UI的短期发病风险,以急迫性尿失禁为主,长期尿失禁患病率随随访年限延长逐渐升高,产次为其发病的独立危险因素。
[Abstract]:Objective: to observe the long-term effect of total hysterectomy on urinary function of patients with non-prolapse benign diseases. To investigate the incidence and risk factors of urinary incontinence (UI) after operation. Methods: from January 2003 to January 2013, benign diseases of non-uterine prolapse were selected in Peking Union Hospital. There was no UI and prolapse before operation. There were 560 cases of total hysterectomy or non-hysterectomy, including 384 cases of total hysterectomy. 176 cases of non-hysterectomy (control group) were followed up by telephone questionnaire. ICIQ-FLUTS) and UDI-6 were used to complete the pre-operation, 1 year, 3 years, 5 years after operation. Objective: to investigate the prevalence of urinary incontinence in patients without prolapse or urinary incontinence after 7 years of subjective urinary function evaluation. Results 264 patients with urinary incontinence completed the questionnaire effectively. Total hysterectomy group (n = 164) and control group (n = 100) (n = 164) and control group (n = 100) were treated with total hysterectomy (n = 164) and control group (n = 100) respectively. The prevalence of UI in the hysterectomy group was significantly higher than that in the control group (P 0.031), but there was no significant difference between the two groups in long-term follow-up. 1 year, 3 years, 5 years and 7 years after operation, there was no significant difference between the two groups. The prevalence of UI in the total hysterectomy group was 8. 5 / 16. 4 / 9. 7 / 10 / 103, respectively. 12. 2 10 / 82) and 16. 7 / 10 / 60. Stress urinary incontinence in the total hysterectomy group (Sui). The postoperative prevalence of UUI was significantly higher than that of the control group. Urgent urinary incontinence is more common than stress urinary incontinence. Conclusion: total hysterectomy increases the short-term risk of UI after hysterectomy, mainly urgent urinary incontinence. The prevalence rate of long-term urinary incontinence gradually increased with the extension of follow-up years, and the birth time was an independent risk factor for the occurrence of urinary incontinence.
【作者单位】：中国医学科学院北京协和医院妇产科;北京市顺义区妇幼保健院;中国医学科学院北京协和医学院;
【分类号】：R713.4
【正文快照】： 全子宫切除术是妇产科临床最常见的手术方式,90%的子宫切除术为治疗妇科良性疾病而施行[1]。文献报道,该手术方式因切断宫骶韧带和(或)主韧带内的盆腔神经组织,改变盆腔的解剖支持结构,对患者的盆腔功能,如泌尿功能、肠道功能及性功能等有不良的影响[2]。研究发现,尿失禁在子

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