经腹子宫全切术后盆底功能障碍影响因素分析

Analysis of the influence factors of pelvic floor dysfunction after transabdominal total hysterectomy

目的:探讨经腹子宫全切术后盆底功能障碍的关联因素,制定应对策略提供参考。方法:回顾性收集2020年1月-2022年11月本院全子宫切除术患者84例临床资料,根据术后1年随访是否并发盆底功能障碍性疾病(PDF)分为PDF组(n=32)、无PDF组(n=52)。收集两组相关临床资料,单因素分析探讨经腹子宫全切术后PDF的可能影响因素,多因素logistic回归分析明确独立影响因素。结果:PDF组32例中包括6例单纯盆腔器官脱垂、4例单纯压力性尿失禁、3例单纯性功能障碍、1例单纯大便失禁,同时伴≥2种18例。两组年龄、体质指数、绝经、孕次、产次、术中出血量、术后留置尿管时间、过早负重等有差异(P<0.05)。多因素分析显示,绝经、术中出血量并非经腹子宫全切术后PDF的独立影响因素(P>0.05),年龄大(OR=1.270、95%CI 1.036~1.558)、体质指数高(OR=2.672、95%CI 1.376~5.190)、孕次多(OR=8.947、95%CI 2.566~31.193)、产次多(OR=12.302、95%CI 3.039~49.802)、术后留置尿管时间长(OR=1.561、95%CI 1.120~2.177)、过早负重(OR=3.713、95%CI 1.628~8.470)均为经腹子宫全切术后发生PDF的独立危险因素(均P<0.05)。结论:经腹子宫全切术后PDF的发生与患者年龄、体质指数、孕次、产次、术后留置尿管时间、过早负重有关,提示临床应依据上述因素识别高风险人群,增强围术期管理。

Objective:To explore the related factors of pelvic floor dysfunction after transabdominal total hysterectomy,and to provide reference for the countermeasures.Methods:The clinical data of 84patients who had undergone total hysterectomy in hospital from January 2020to November 2022were collected retrospectively.These patients were divided into group A(32case with pelvic floor dysfunction(PDF))and group B(52case without PDF)according to whether the patients with PDF complicated or not in 1year after operation.The relevant clinical data of the patients in the two groups were collected.Univariate analysis was used to explore the possible influencing factors of the PDF occurrence of the patients after total hysterectomy,and then the independent influencing factors of the PDF occurrence of the patients were identified by multivariate logistic regression analysis.Results:In group A,there were 6cases with simple pelvic organ prolapse,4cases with simple stress urinary incontinence,3cases with simple sexual dysfunction and 1case with simple fecal incontinence,and there were 18cases with more than two kinds of PDF.There were significant differences in the age,the body mass index,the menopause situation,the gravidity,the parity,the intraoperative blood loss,the time of postoperative indwelling catheter,and the early weight bearing situation of the patients between the two groups(P<0.05).Multivariate analysis showed that the menopause and the intraoperative blood loss of the patients were not the independent influencing factors of their PDF occurrence after transabdominal total hysterectomy(P>0.05).The advanced age(OR=1.270,95%CI 1.036-1.558),the higher body mass index(OR=2.672,95%CI 1.376-5.190),the more gravidity(OR=8.947,95%CI 2.566-31.193),the more parity(OR=12.302,95%CI 3.039-49.802),the longer time of postoperative indwelling catheter(OR=1.561,95%CI 1.120-2.177)and the early weight bearing(OR=3.713,95%CI 1.628-8.470)of the patients with transabdominal total hysterectomy were the independent risk factors of their PDF occurrence(all P<0.05).Conclusion:The PDF occurrence of the patients after transabdominal total hysterectomy is related to their age,body mass index,gravidity,parity,time of postoperative indwelling catheter and early weight-bearing.It is suggested that the high-risk patients with PDF should be identified based on the above factors,so as to enhance the perioperative management of the patients.