盆底脏器脱垂患者与下尿路功能障碍关系的探讨

Exploration of the relationship between pelvic organ prolapse and lower urinary tract dysfunction

目的探讨盆底脏器脱垂患者与下尿路功能障碍之间的关系。方法于2009年7月-2010年11月对54例诊断为盆腔脏器脱垂的住院患者进行病史采集、妇科检查、POP—Q评分及尿动力学检查，探讨盆腔脏器脱垂与下尿路功能障碍的关系。结果54例POP患者中，出现下尿路主观症状44例，其中尿失禁症状27例（压力性24例，急迫性1例，混合性2例），尿急和／或尿频27例，排尿功能障碍16例。尿动力学检查结果显示：压力性尿失禁28例，急迫性尿失禁2例，混合性尿失禁2例，伴膀胱顺应性降低1例，腹压排尿3例。腹部漏尿点压力（ALPP）〈60cmH2O有10例，60～90cmH2O13例，〉90cmH2O7例。与尿失禁主观症状的符合率为70％（19／27）；隐匿性尿失禁的发生率为41％（11／27），均为重度阴道前壁脱垂的患者。结论POP患者术前在减轻脱垂程度情况下行尿动力学检查可更客观地评价下尿路功能障碍，POP患者术前应了解膀胱及尿道括约肌功能，注意排除隐匿性尿失禁。

Objective To explore the relationship between pelvic organ prolapse and lower urinary tract dysfunction. Methods From July, 2009 to November, 2010, collected the medical history of 54 patients diagnosed with pelvic organ prolapse, and conducted gynecological examination and pelvic organ prolapse quantitative examination （ POP-Q ） on them, then explored the relationship between pelvic organ prolapse and lower urinary tract dysfunction. Results Among all the patients with POP, 44 cases developed subjective symptoms of lower urinary tract, among which, 27 cases had urinary incontinence （ 24 with stress, 1 with urgency, 2 with mixed incontinence ） 27 cases got bladder irritation; 16 cases underwent with voiding dysfunction. The urodynamic tests revealed that： 28 cases had stress urinary incontinence , 2 cases had urgent incontinence, 2 cases got mixed incontinence, 1 case had reduced bladder compliance, and 3 cases had abdominal voiding. There were 10 cases with abdominal leak point pressure （ ALPP ） 〈 60 cmH20, 7 cases between 60-90 cmH20, 13 cases 〉 90 cmH20.70%（ 19/27 ） of the patients with symptoms of stress incontinence were confirmed genuine incontinence by urodynamics test; the incidence of occult incontinence was 41% （ 11/27 ）, all of which were diagnosed with severe anterior vaginal wall prolapse. Conclusions Prior to the operation, testing the urodynamics of POP patients under the condition of relieving the severity of pelvic organ prolapse can more objectively assess urinary tract dysfunction. Patients with POP before surgery should be informed the bladder and urethral sphincter function, and should pay attention on occult incontinence.