盆腔器官脱垂与宫颈增大、宫颈阴道部延长的关系分析

Ratio analysis of the vaginal cervical hypertrophy,elongation and pelvic organ prolapse

目的探讨盆腔器官脱垂与宫颈增大、宫颈阴道部延长的相关性。方法选取中国医科大学附属盛京医院2015年3月至2016年11月符合纳入标准的妇科患者997例,采用盆腔器官脱垂评分(POP-Q)将患者分为脱垂组(496例)与非脱垂组(501例),通过阴道内测量,得到宫颈的前后径d2、横径d1、宫颈阴道部长度d3(POP-Q评分中C-D点之间的差值)。文章暂定义宫颈增大、宫颈阴道部延长的临界值,即宫颈增大:未绝经患者为d1≥2.98 cm、d2≥2.87 cm、绝经患者为d1、d2均≥2.81 cm;宫颈阴道部延长:未绝经患者为d3≥3.92 cm、绝经患者为d3≥3.9 cm,按此临界值筛选出宫颈增大、宫颈阴道部延长的患者。结果未绝经的患者,其中非盆腔器官脱垂与盆腔器官脱垂发生宫颈增大、宫颈阴道部延长的比率分别为35.39%、55.84%,差异有统计学意义(P<0.05);绝经患者,非盆腔器官脱垂与盆腔器官脱垂发生宫颈增大、宫颈阴道部延长的比率分别为17.50%、20.72%,差异无统计学意义(P>0.05);子宫脱垂为主的中盆腔器官脱垂发生宫颈增大、宫颈阴道部延长的比率远高于阴道前后壁脱垂的比率(P<0.05)。结论未绝经患者宫颈增大、宫颈阴道部延长与盆腔器官脱垂有显著相关性;尤其是中盆腔器官脱垂与宫颈增大、宫颈阴道部延长有明显相关性,可能与宫颈周围立体环的损伤有关系。

Objective To study the relationship of pelvic organ prolapse with vaginal cervical hypertrophy and elongation. Methods Select a total of 997 patients treated in Shengjing Hospital Affiliated to China Medical University who conformed with our recruited criteria from Mar. 2015 to Nov. 2016;according to the pelvic organ prolapse quantitative scale（pop-q score）,the patients were divided into prolapse and non-prolapse group,with respectively 496 cases and501 cases. We measured them by compass inside the vagina and obtained cervical anteroposterior diameter d2,transverse diameter d1,vaginal cervix length d3（the difference between C and D point in POP-Q scoring）.We temporarily defined the threshold value of cervical hypertrophy and cervical elongation,that is,cervical enlargement：without postmenopausal：d1≥2.98 cm,d2≥2.87 cm,and postmenopausal women：d1 and d2≥2.81 cm;the vaginal cervical elongation：menopausal women with d3 ≥ 3.92 and postmenopausal women with d3 ≥3.9 cm,and then we selected patients according to this value.Results In premenopausal patients,the rate of cervical enlargement and the vaginal cervical elongation was 35.39 % and 55.84 %,respectively in the non-POP and POP patients,and the difference was statistically significant（P〈0.05）;in menopausal patients the rates were 17.50 % and 20.72 %,repectively,with no statistical significance compared with the premenopausal women（P〉0.05）.The rate of cervical enlargement and elongation in mid-pelvic organ prolapse was significantly higher than that in vaginal anterior and posterior wall prolapse（P〈0.05）.Conclusion There is a significant correlation between hypertrophy and elongation of the vaginal uterine cervix and prolapse in premenopause patients,which may be related to the damage of the three-dimensional ring around the cervix.