阴道封闭术对老年盆腔器官脱垂患者肠道困扰症状的疗效观察

Effects of colpocleisis on bothersome bowel symptoms of elderly women with severe prolapse of pelvic organs

目的:观察阴道封闭术对老年重度盆腔器官脱垂(POP)患者肠道梗阻及失禁等肠道困扰症状的疗效。方法:在2005年10月—2010年2月期间,采用盆底功能障碍症状问卷结直肠肛门困扰量表(CARDI-8)及生活质量问卷结直肠肛门影响问卷(CARIQ-7),对60例因POP-QⅢ～Ⅳ期重度POP而实施阴道封闭手术的患者,分别于术前及术后2个月、6个月及1年进行肠道困扰症状以及生活质量调查。问卷评分越低表明肠道困扰症状越轻,对患者生活质量影响越小。结果:术后2个月、6个月及1年时随访率分别为93%(56/60例)、88%(53/60例)和87%(52/60例)。11例术前有排便梗阻者于术后2个月时有6例症状消失,其余5例有不同程度改善。3例粪失禁者于术后2个月时有2例症状缓解,1例无改善。术后无新发肠道困扰症状。CARDI-8与CARIQ-7在术前及术后2个月、6个月及1年时的平均得分依次为(12.92±15.80)分、(5.19±7.18)分、(4.57±5.95)分、(4.48±5.93)分和(8.10±14.33)分、(4.51±8.92)分、(3.85±5.97)分、(3.78±5.93)分,术后评分较术前均有显著下降(P_(CARDI-8)=0.000 0,P_(CARIQ-7)<0.01)。结论:阴道封闭手术可以有效缓解老年POP患者排便梗阻症状并改善患者的生活质量;对粪失禁的疗效仍有待于进一步的临床研究。

Objective：To observe the effects of colpocleisis on bothersome bowel symptoms such as obstructive defecation and fecal incontinence in elderly women with sever pelvic organ prolapse （POP）. Methods： From October 2005 to February 2010, 60 severe POP patients with stage Ⅲ and Ⅳ according to POP-Q system underwent total and partial colpocleisis. Patients completed the colorectal-anal distress inventory （CARDI-8） and colorectal-anal impact questionnaire （CARIQ-7） before the operation, and they were repeated 2 months, 6 months and 1 year after the operation. Results： Among the 60 patients,there were 56 （93%） ,53 （88%） and 52 （87%） patients completed the questionnaires at 2 months, 6 months and 1 year after operation respectively. In 11 patients with symptoms of obstructive constipation, 6 of them were relieved of the symptoms, and in the other 5 patients it was improved at 2 months after surgery. In 3 patients with fecal incontinence, it was improved in 2 patients, and there was no improvement in the other one. No de novo bowel symptoms occurred after surgery. This improvement was maintained 1 year later. Mean CARDI-8 score was improved significantly from 12.92± 15.80 before operation to 5.19±7.18 at 2 months, 4.57±5.95 at 6 months and 4.48±5.93 at 1 year after the operation（P=0. 000 0）. Mean CARIQ-7 score was improved significantly from 8.10± 14.33 before operation to 4.51 ± 8.92 at 2 months, 3.85±5.97 at 6 months and 3.78±5.93 at 1 year after the operation（P〈0.01）. Conclusions： Colpocleisis effectively relieaved bothersome obstructive symptoms related to pelvic organ prolapse and improved patients＇ quality of life . Its effects on fecal incontinence warrants further research.