盆腔器官脱垂患者肛肠动力学改变的临床研究

Clinical study of pelvic organ prolapse about anorectal dynamics

目的探讨盆腔器官脱垂（POP）患者排便症状及肛肠动力学改变，评价POP对肛肠功能的影响。方法收集2011年11月至2013年3月于深圳市人民医院妇科住院治疗的绝经后POP患者共计59例为研究对象，纳入POP组。选择同期在本院妇科住院治疗的绝经后非POP患者共计46例，纳入对照组。对两组患者进行肛管、直肠压力参数测定，以及《直肠功能障碍生活质量调查问卷》调查，评价POP对患者肛肠功能的影响。本研究遵循的程序符合深圳市人民医院人体试验委员会制定的伦理学标准，得到该委员会批准，并与患者本人签署知情同意书。结果①两组患者年龄、孕次、产次、绝经时间及人体质量指数等一般资料比较，差异均无统计学意义（P〉0．05）。②POP组阴道前壁脱垂Ⅱ度＋Ⅲ度与Ⅳ度、子宫脱垂Ⅰ～Ⅲ度与Ⅳ度、阴道后壁脱垂Ⅰ度＋Ⅱ度与Ⅲ度＋Ⅳ度患者的肛管静息压、肛管最大收缩压、直肠最小感觉容量、初始排便容量及最大阈值容量分别比较，差异均无统计学意义（P〉0．05）。③POP组伴排便困难患者的直肠初始排便容量及最大阈值容量，均显著大于该组无排便困难患者，差异均有统计学意义（t=4．93、4．67，均为P=0．000）；而其肛管静息压、最大收缩压及直肠最小感觉容量分别比较，差异却均无统计学意义（P〉0．05）。④本研究对POP组与对照组患者共计发放《直肠功能障碍生活质量调查问卷》115份，最终收集有效问卷115份，问卷有效回收率为100％。POP组患者的《直肠功能障碍生活质量调查问卷》评分，显著高于对照组，并且差异有统计学意义（t=4．81，P=0．000）。⑤POP组患者肛管静息压、肛管最大收缩压均分别低于对照组，差异均有统计学意义（t=3．15、3．43，P=0．002、0．001）。POP组患者直肠最小感觉容量、初始排便容量及最大阈值容量，均分别高于对照组，并且差异亦均有统计学意义（t=3．42、3．95、3．83，P=0．001、0．000、0．000）。结论POP患者排便功能明显下降，生活质量低下，常伴有排便困难、排便不尽和大便失禁等症状。POP患者肛门、直肠收缩能力及感觉功能明显下降，与POP严重程度无相关性，直肠感觉功能下降与是否合并排便困难有关。

Objective To study the symptoms, and anorectal dynamics in women with pelvic organ prolapse （POP）, so as to comprehensively assess anorectal dysfunction in POP. Methods A total of 59 cases of postmenopausal patients with POP in Shenzhen people＇s Hospital from November 2011 to March 2013 were included in the POP group, at the same time 46 cases of postmenopausal patients without POP in the same hospital were included as control group. They were evaluated with a validated questionnaire （Colorectal-anal Distress Inventory 8）, and anorectal manometry to assess the anorectal dysfunction of POP. The study followed the ethical standards of the human trials of the Shenzhen People＇s Hospital, approved by the committee, and clinical research informed consent was signed by each patient. Results （1）There were no statistically significant differences between two groups among age, gravidity, parity, the duration of menopause, and body mass index （P〈0.05）. （2）There were no statistically significant differences between the POP patients of anterior vaginal wall prolapse Ⅱ degree＋Ⅲ degree and IV degree, uterus prolapse Ⅰ-Ⅱ degree and Ⅳ degree, posterior vaginal wall prolapsed Ⅰ degree＋ Ⅱ degree and Ⅲ degree＋ IV degree among resting and squeezing pressure and the rectum capacity of minimal sensation, normal defecation and strong defecation （P〈0.05）. （2）There were bigger rectum capacity of normal defecation and stronger defecation in POP patients with difficult defecation than those of patients without difficult defecation, and the differences were statistically significant （t = 4. 93, 4. 67% both P = 0. 000）. But there were no statistically significant differences between the two groups among resting and squeezing pressure and the rectum capacity of minimal sensation （P〈0.05）. （4）A total of 115 sets of Colorectal-anal Distress Inventory 8 questionnaires were handed out to POP group and control group, and 115 sets of valid questionnaires were collected, the feedback rate of the questionnaires were 100%. The POP group got more scores in questionnaires than control group, and the difference was statistically significant （t = 4. 81, P = 0. 000）. （5）There were lower resting and squeezing pressure in POP patients than those in control group, and the differences were statistically significant （t=3.15, 3.43; P=0. 002, 0. 001）. There were bigger rectum capacity of minimal sensation, normal defecation and stronger defecation in POP patients than those in control group, and the differences wre statistically significant （t= 3.42, 3.95, 3.83; P=0. 001, 0. 000,0. 000）. Conclusions Patients with POP is often associated with a variety of symptoms, including difficult defecation, fecal incontinence endless defecate, which lead to the lower quality of life. The anorectal contraction and sensory function are decreased in patients with POP, but they are not associated with the degree of posterior vaginal wall prolapsed, but with the POP with difficulty defecating or not.