非脱垂全子宫切除术后尿失禁发病率及危险因素——7年回顾性队列研究

The prevalence and potential risk factors of urinary incontinence after hysterectomy: 7-year retrospective cohort study

目的：观察因非脱垂良性疾病行全子宫切除术对患者泌尿功能的长期影响,并探讨术后尿失禁（UI）的发生率及其危险因素。方法：选取2003年1月至2013年1月在北京协和医院因非子宫脱垂良性疾病（术前均无UI及脱垂,术后病理结果证实）行全子宫切除术或非子宫切除术者共560例,其中行全子宫切除术者384例,非子宫切除术者176例（对照组）。分别进行电话问卷随访,通过中文验证版女性下尿路症状国际尿失禁标准问卷（ICIQ-FLUTS）及尿道疾病程度分类问卷（UDI-6）完成术前、术后1年、3年、5年、7年的主观泌尿功能评价调查,观察术前无脱垂或尿失禁患者术后尿失禁的患病情况。结果：264例患者有效完成问卷,其中全子宫切术组164例（62.1%）,对照组100例（37.9%）。术后1年时,全子宫切除术组的UI患病率显著高于对照组（P=0.031）,而长期随访发现两者并无显著差异（P〉0.05）。术后1年、3年、5年和7年,全子宫切除组患者的UI患病率分别为8.5%（14/164）、9.7%（10/103）、12.2%（10/82）和16.7%（10/60）。全子宫切术组的压力性尿失禁（SUI）、急迫性尿失禁（UUI）等症状的术后患病率均明显高于对照组;急迫性尿失禁较压力性尿失禁常见。多因素分析发现,多产为UI发生的独立危险因素（OR=3.87,95%CI为1.12-13.33）。结论：全子宫切除术增加术后UI的短期发病风险,以急迫性尿失禁为主,长期尿失禁患病率随随访年限延长逐渐升高,产次为其发病的独立危险因素。

Objective： To investigate long-term urinary functions,the prevalence and potential risk factors of urinary incontinence（ UI） after total abdominal hysterectomy for nonprolapse dieases. Methods： From Jan. 2003 to Jan. 2013,560 patients with benign gynecological diseases（ without preoperative pelvic organ prolapse（ POP） or UI,the postoperative pathological diagnosis were benign gynecological diseases） and underwent abdominal surgeries by the same senior gynecologist at Peking Union Medical College Hospital（ PUMCH） were retrospectively enrolled,which including 384 patients with hysterectomy and 176 patients without it. A telephone interview based on two Chinese questionnaires（ Incontinence questionnaire female lower urinary tract symptom questionnaire,ICIQ-FLUTS and Urinary distress inventory 6,UDI-6） were carried on to survey their urinary symptoms and the prevalence of UI at preoperative,and 1-yr,3-yr,5-yr,7-yr after surgery. Results： 264 patients completed the questionnaires,which including 164（ 62. 1%） patients with hysterectomy and 100（ 37. 9%） patients without it. The patients in hysterectomy group showed a significant higher incidence of UI than control group 1 year after surgery（ P = 0. 031）,however,long term follow-up did not show any significant differences（ P〉0. 05）. The prevalence of UI increased with follow-up years and it was8. 5% at 1-yr,9. 7% at 3-yr,12. 2% at 5-yr and 16. 7% at 7-yr after surgery. Urgency incontinence（ UUI） and stress urinary incontinence（ SUI） were more prevalent in patients with hysterectomy than that in the control group. UUI was more prevalent than SUI. Multiparous was independent risk factor of UI（ OR = 3. 87,95% CI 1. 12 - 13. 33）. Conclusion： The prevalence of UI increases significantly in patients with hysterectomy shortly after surgery,especially UUI. The prevalence of UI increases with follow-up years. Multiparous is independent risk factor of it.