重度盆腔器官脱垂患者选择手术治疗或子宫托治疗的影响因素

Factors influencing therapy decision in patients with severe pelvic organ prolapse

目的探讨重度盆腔器官脱垂（POP）患者选择手术治疗或子宫托治疗的影响因素。方法采用回顾性研究方法，收集2008年1月1日至2013年12月31日就诊于北京大学第三医院、有症状且要求治疗、无POP手术及子宫托治疗禁忌证的Ⅲ~Ⅳ度POP患者的临床资料，按患者意愿分为手术治疗（手术组）或子宫托治疗（子宫托组）两组共419例，比较两组患者的临床特点，包括就诊时年龄、体质指数（BMI）、发病年龄及患病年限、脱垂严重程度、有无POP手术史、内科合并症的差异。结果419例POP患者中手术组占67.5%（283/419），子宫托组占32.5%（136/419）。手术组患者BMI为（25.1±3.5）kg/m2，子宫托组为（23.8±2.6）kg/m2，两组比较，差异有统计学意义（P〈0.01）。手术组患者的发病年龄为（62±12）岁，子宫托组为（57±11）岁，两组比较，差异有统计学意义（P〈0.01）。手术组患者的患病年限为（5±8）年，子宫托组为（11±11）年，两组比较，差异有统计学意义（P〈0.01）。中盆腔脱垂分度手术组高于子宫托组（分别为3.0±1.2、2.5±1.2），两组比较，差异有统计学意义（P〈0.01）。手术组患者合并心脏疾病的比例（20.1%，57/283）少于子宫托组（30.9%，42/136），两组比较，差异有统计学意义（P=0.015）。以logistic回归分析以上有差异的因素，BMI（OR=1.141，95%CI为1.061~1.226，P〈0.01）、患病年限（OR=0.932，95%CI为0.910~0.955，P〈0.01）、中盆腔脱垂分度（OR=1.389，95%CI为1.171~1.647，P〈0.01）是POP患者选择治疗方式的独立影响因素。结论在患者自愿选择的基础上，选择手术治疗者占67.5%，选择子宫托治疗者占32.5%。选择手术治疗的患者中，BMI高、合并心脏疾病者的比例小、中盆腔脱垂分度重。选择子宫托治疗的患者中，相对发病年龄小、患病年限长。

Objective To investigate the factors influencing therapy decision of surgery or pessary in patients with severe pelvic organ prolapse （POP）. Methods Totally 419 cases ofⅢtoⅣdegree POP patients were studied retrospectively. Patients were divided into surgery and pessary groups according to their own choice. Clinical characters were compared such as age, body mass index （BMI）, age of onset and disease duration, POP stage, complications. Results 67.5%（283/419） patients were in the surgical group and 32.5%（136/419） patients in the pessary group. Patients in surgical group had higher BMI [（25.1 ± 3.5） versus （23.8±2.6） kg/m2], elder age of onset [（62±12） versus （57±11） years old], longer disease duration [（5± 8） versus （11±11） years] and higher POP staging of middle compartment and less cardiac disease [20.1%（57/283） versus 30.9% （42/136）] than those in pessary group, all had significant difference （P〈0.05）. Logistic regression analysis on the above factors showed a statistically significant difference between two groups, BMI, disease duration and POP staging of middle compartment were independent factors （OR=1.141, 0.932, 1.389;all P〈0.01）. Conclusions Patients with higher BMI, higher POP staging of middle compartment and less cardiac disease tended to choose surgery. Patients with younger age of onset and longer disease duration tended to choose pessary. Factors as age, POP staging of anterior and posterior compartment, history of POP surgery, complicated with hypertension and diabetes, showed no influence on treatment choice.