改进盆底重建手术对下尿路症状的影响

Effects of the modified pelvic floor reconstructive surgery on lower urinary tract symptoms

目的探讨盆腔器官脱垂患者行改进盆底重建手术后排尿情况及下尿路症状的变化,以及术中合用经闭孔尿道中段无张力悬吊手术(TVT-O吊带及TVT-O网片吊带)对活动后漏尿及下尿路症状的影响。方法前瞻性研究盆腔器官脱垂(POP)患者112例,合并或不合并下尿路症状,行改进盆底重建手术前、术后排尿状况及生活质量。结果①86例随访半年的患者中,术前84.9%(73/86)有下尿路症状,术后有下尿路症状者50%(43/86),较术前症状改善或消失者76.7%(56/73);47例随访达1年,下尿路症状改善者59.6%(28/47)。②盆底功能障碍调查问卷PFDI、UDI评分术前术后比较,有统计学意义(P<0.05)。③单纯改进盆底重建术、改进盆底重建手术与TVT-O联合使用,均可改善下尿路症状(P<0.05),加用TVT-O效果优于单纯改进盆底重建术(P<0.05)。结论①改进盆底重建手术对盆腔器官脱垂患者的下尿路症状有改善作用;②对于术前有活动后漏尿或隐匿性压力性尿失禁的患者,加用TVT-O手术比单纯改进盆底手术能更有效的治疗排尿症状。

Objective To investigate the urination conditions in patients after the pelvic floor reconstructive surgery （PRS） for pelvic organ prolapse （POP）, as well as effects of TVT - O used in the operation for urination conditions. Methods A prospective study on preoperative, postoperative urination conditions and qualities of life was conducted in 112 POP patients, with or without lower urinary tract symptoms （LUTS）, underwent PRS. Resuits With preoperative questionnaires 73/86 （84. 9%） presented with LUTS. For the 86 patients who are followed up for half a year, and 56 （76.7%） showed alleviated or eliminated symptoms. For the 47 who are followed up for one year, 28 （59. 6%） show alleviated. PFDI and UDI improved postoperatively with statistic significance （P〈 0. 05）. PRS alone was less effective than PRS and TVT - O to LUTS （P〈0. 05）. Conclusions PRS could alleviate LUTS of patients with POP. RPS and TVT - O operations are more effective than PRS alone in treating the urination symptoms.