盆底重建术对盆腔器官脱垂患者下尿路功能的影响

发布时间：2018-05-16 08:04

本文选题：盆底重建术 + 盆腔器官脱垂　；参考：《福建医科大学》2014年硕士论文

【摘要】：【目的】通过尿动力学检查方法对盆腔器官脱垂（pelvic organ prolapse，POP）患者的膀胱尿道功能进行评估，结合泌尿生殖道症状问卷（Urinary DistressInventory-6，UDI-6）患者自评，探讨POP患者下尿路功能情况；并比较经阴道植入网片的盆底重建术（transvaginal placement of surgical mesh for pelvic organand prolapse，TVM）手术前后患者的尿动力学参数及问卷评分的变化，进一步研究TVM术对POP患者下尿路功能的影响，为后期POP合并显性或隐匿性尿失禁的临床治疗提供新的思路和依据。【方法】 1、第一部分盆底器官脱垂患者下尿路功能的研究选取60例盆腔器官脱垂患者，通过尿动力学检查及患者使用UDI-6主观评估自身的下尿路症状，综合评估POP患者下尿路功能。 2、第二部分盆底重建手术对盆底器官脱垂患者下尿路功能的影响选取30例中重度盆腔器官脱垂患者于术前、术后3个月分别用尿动力学检查方法检测其初始排尿感膀胱容量（VFD）、常态排尿欲膀胱容量（VND）、强烈排尿感膀胱容量（VSD）、最大膀胱容量（MCC）、最大尿流率（Qmax）、排尿后膀胱残余尿量（PVR）、最大尿道压力（MUP）、最大尿道闭合压（MUCP）、功能性尿道长度（FUL）等相关参数，如检查中发现合并有压力性尿失禁，则记录腹压漏尿点压（ALPP）值；并同时在术前、术后3个月，通过患者使用UDI-6获得下尿路症状的主观评分。利用统计软件SPSS16.0进行数据统计分析，计数资料采用χ2检验，对手术前后尿动力学相关参数的比较采用配对t检验，P值＜0.05则认为所检验的差别有统计意义。借此，探讨TVM术对中重度POP患者下尿路功能的影响。【结果】 1、60例POP患者Ⅲ度18例，Ⅳ度42例。98.33%的患者合并有下尿路症状，经临床症状分析诊断为SUI、UUI、MUI、排尿功能障碍、尿频，分别占6.67%、5%、11.67%、33.33%、41.67%；而尿动力学检查诊断为USUI、DO、MUI和排尿功能障碍，各占38.33%、11.67%、10%、36.67%。虽然两者的诊断结果存在一致性（P=0.005），但其一致性较差（Kappa值=0.310）。 56例POP患者行自由尿流率检测时尿峰值流率为16.35±4.46ml/s，其中，有8例患者尿流率偏低（Qmax≤10ml/s），，16例患者PVR≥50ml。POP组和POP合并USUI组相比较，前者膀胱感觉容量稍大，MUP、MUCP压力值略高，但差别无明显的统计学意义（P＞0.05），而后者FUL明显缩短，差异有统计学意义（P＜0.05）。 2、30例POP患者经TVM手术治疗，短期解剖治愈率达100%，随访中未发现严重并发症。术后3个月患者UDI-6评分平均值较术前明显降低，经统计分析具有显著差异（P＜0.05），泌尿生殖道症状明显减轻，生活质量改善情况好。患者术后下尿路症状的发生率明显降低（P＜0.05），排尿功能障碍及尿频的症状得到明显改善（P＜0.05），而尿急、SUI和MUI的症状在手术前后无显著性差异（P＞0.05）。行自由尿流率检查，1例POP患者患有严重的UUI，无法憋尿完成自然状态下尿流率测定，29例患者术后Qmax较术前明显增高，经统计学分析有显著差异（P＜0.05）。术前检查发现有6例尿潴留（PVR≥50ml），而术后均无一例发生。膀胱尿道功能检测结果，术后VFD、VND、VSD、MCC均较术前明显减小，其差异有统计学意义（P＜0.05）；MUP、MUCP升高，FUL延长，但差异无显著的统计学意义（P＞0.05）。【结论】 1、尿动力学检查，结合UDI-6患者自评，可以综合反映POP患者的下尿路功能情况，对合并下尿路功能障碍的诊治有重要意义； 2、TVM术是治疗POP的有效手段，手术解剖复位佳，患者的主观脱垂症状、下尿路症状的总体情况得到明显改善； 3、建议POP患者手术前均应行尿动力学检查以明确其下尿路功能情况； 4、TVM术在治疗中重度POP的同时，对合并轻中度的尿失禁者亦有很好的预防和治疗作用。
[Abstract]:[Objective]
The urinary bladder and urethra function of patients with pelvic organ prolapse (POP) was evaluated by urodynamic examination, and the function of lower urinary tract in POP patients was evaluated by self evaluation of the urogenital symptom questionnaire (Urinary DistressInventory-6, UDI-6), and the pelvic floor reconstruction by transvaginal mesh (transvaginal) was compared. Placement of surgical mesh for pelvic organand prolapse, TVM) changes in urodynamic parameters and questionnaire scores of patients before and after operation, and further study the effect of TVM on the urinary tract function of POP patients, and provide new ideas and basis for the clinical treatment of later POP with dominant or occult incontinence.
[method]
1. Part one study of lower urinary tract function in patients with pelvic organ prolapse
60 cases of pelvic organ prolapse were selected to evaluate the lower urinary tract function of POP patients through urodynamic examination and the patients' subjective assessment of their own lower urinary tract symptoms using UDI-6.
Effect of 2 and second parts of pelvic floor reconstruction on lower urinary tract function in patients with pelvic organ prolapse
30 cases of moderate and severe pelvic organ prolapse were selected before the operation, and 3 months after operation, the urinary bladder capacity (VFD), urinary bladder capacity (VND), strong urination bladder capacity (VSD), maximum bladder capacity (MCC), maximum urinary flow rate (Qmax), urinary bladder residual urine volume (PVR), maximum urethra after urination were measured. Pressure (MUP), maximum urethral closure pressure (MUCP), functional urethral length (FUL) and other related parameters, such as the detection of pressure urinary incontinence in the examination, recorded the point pressure (ALPP) of the abdominal pressure leaking urine (ALPP); and at the same time, 3 months after the operation, the subjective score of the symptoms of the lower urinary tract was obtained by the use of UDI-6. The statistics software SPSS16.0 was used to carry out the data. Statistical analysis, the count data were tested by the x 2 test. The paired t test was used to compare the parameters of the urodynamic parameters before and after the operation, and the value of P was less than 0.05, and the difference was statistically significant. Therefore, the effect of TVM on the lower urinary tract function of the patients with moderate and severe POP was discussed.
[results]
1,60 cases of POP patients were 18 cases, and 42 cases of IV degree.98.33% were combined with lower urinary tract symptoms. The clinical symptoms were diagnosed as SUI, UUI, MUI, urination dysfunction, frequency of urination, respectively 6.67%, 5%, 11.67%, 33.33%, 41.67%, while urodynamic examination was diagnosed as USUI, DO, MUI, and micturition dysfunction, each accounted for 38.33%, 11.67%, 10%, 36.67%. although they were 38.33%, 11.67%, 10%, 36.67%. although both were 38.33%. The diagnostic results were consistent (P=0.005), but their consistency was poor (Kappa =0.310).
The urine peak flow rate of 56 patients with POP was 16.35 + 4.46ml/s, of which 8 cases had lower urinary flow rate (Qmax < 10ml/s). 16 patients with PVR > 50ml.POP group and POP combined USUI group, the former bladder sensory capacity was slightly larger, MUP, MUCP pressure was slightly higher, but there was no significant difference (P > 0.05), and the latter FUL. The difference was statistically significant (P < 0.05).
2,30 patients with POP were treated with TVM operation, the short-term anatomical cure rate was 100%. No serious complications were found during the follow-up. The mean value of UDI-6 score was significantly lower than that before operation. The statistical analysis had significant difference (P < 0.05). The symptoms of genitourinary tract were obviously alleviated and the quality of life improved. The symptoms of lower urinary tract after operation were found. The birth rate was significantly lower (P < 0.05). The symptoms of urination dysfunction and frequency of urination were obviously improved (P < 0.05), while the symptoms of SUI and MUI were not significant before and after operation (P > 0.05).
In 1 cases of POP patients with severe UUI, the urine flow rate was detected in the natural state of the patients with severe UUI. The postoperative Qmax was significantly higher than before the operation (P < 0.05). The preoperative examination revealed that there were urinary retention (PVR > 50ml), and none of them occurred after the operation. The urinary bladder urethral function test results were found. After operation, VFD, VND, VSD and MCC were significantly lower than those before operation, and the difference was statistically significant (P < 0.05); MUP, MUCP increased, FUL prolonged, but the difference was not statistically significant (P > 0.05).
[Conclusion]
1, urodynamic examination, combined with the self evaluation of UDI-6 patients, can comprehensively reflect the lower urinary tract function of POP patients, which is of great significance for the diagnosis and treatment of the dysfunction of the lower urinary tract.
2, TVM is an effective way to treat POP. Surgical anatomy and reduction are better. The subjective prolapse symptoms and lower urinary tract symptoms of patients are improved significantly.
3, it is suggested that POP patients should perform urodynamic examination before operation to identify their lower urinary tract function.
4, TVM in the treatment of moderate and severe POP, at the same time, combined with mild to moderate urinary incontinence also has a good preventive and therapeutic effect.

【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713

【参考文献】