以便秘为主诉的女性盆底功能障碍患者症状分布

Symptom distribution of female pelvic floor dysfunction patients with constipation as chief complaint

目的观察以便秘为主诉的女性盆底功能障碍（FPFD）患者的症状分布、严重度及生活质量。方法采用描述性病例系列研究方法，收集2015年9月至2017年2月期间，南京市中医院盆底中心专病门诊以便秘为主诉的FPFD患者100例为研究对象，回顾性收集病史，汇总包括肛门痛、阴道痛、尿道痛、尿失禁、夜尿症、尿频、排尿障碍和直肠前突等合并症状，并对以下常见症状的严重程度和患者生活质量进行评价。针对便秘主诉症状，填写便秘严重度评分表（分值越高，便秘越严重）和便秘患者生活质量问卷（分值越高，生活质量越差）；根据患者合并症状，填写相应量表：（1）合并肛门痛，填写疼痛视觉模拟评分（分值越高，疼痛越严重）和SF-36生活质量问卷（分值越高，生活质量越好）；（2）合并尿失禁，填写国际尿失禁调查问卷（分值越高，失禁越严重）和尿失禁生活质量影响问卷（分值越高，生活质量越好）；（3）合并排粪失禁，填写排粪失禁严重度评分表（分值越高，失禁越严重）和排粪失禁生活质量问卷（分值越高，生活质量越好）。结果100例以便秘为主诉的FPFD患者年龄24-89（57.9±13.9）岁，病程0.5-40.0（7.0±8.2）年。75例（75%）合并肛门痛，70例（70%）合并尿失禁，37例（37%）合并直肠前突，19例（19%）合并夜尿症，11例（11%）尿频，10例（10%）排粪失禁。仅合并1种症状者占20%（20/100），合并2种及以上症状占80%（80/100），合并症状以盆底松弛综合征（58%，58/100）为主。本组FPFD患者便秘的严重度为6-22（13.9±3.8）分，生活质量评分为45-133（87.1±18.6）分。便秘合并肛门痛的FPFD患者严重度为1-8（3.0±1.9）分，生活质量评分为14.4-137.0（71.5±31.4）分。便秘合并尿失禁的FPFD患者严重度为1-17（6.1±3.6）分，生活质量评分为52-110（90.0±15.8）分。便秘合并排粪失禁的FPFD患者严重度为1-11（4.4±3.0）分，生活质量评分为52-116（83.4±23.3）分。结论以便秘为主诉的FPFD症状繁杂，以合并肛门病为主，其次尿失禁，大多合并2种以上症状，患者生活质量差。

Objective To observe the multiple symptom distribution, severity and quality of life of female pelvic floor dysfunction （FPFD） patients with constipation as chief complaint. Methods One hundred FPFD patients with constipation as chief complaint from Speciaty Outpatient Clinic, Pelvic Floor Center of Nanjing Municipal Hospital of Traditional Chinese Medicine between September 2015 and February 2017 were retrospectively enrolled in this study. A comprehensive medical history questionnaire survey and systematical evaluation of severity and quality of life of these patients with constipation was conducted. Constipation scoring system scale （CSS） and patient-assessment of constipation quality of life questionnaire （PAC-QOL） were applied to evaluate the constipation. Other scales included： （1）pain visual analogue scale （VAS） and short form-36 questionnaire （SF-36）： if combined with chronic functional anal rectal pain; （2） international consultation on incontinence questionnaire-short form （ICIQ-SF） and urinary incontinence quality of life questionnaires （I-QOL）：if combined with urinary incontinence; （3） fecal incontinence severity score scale （Wexner-FIS） and fecal incontinence quality of life questionnaire （FI-QOL） ：if combined with fecal incontinence. Results The mean age of 100 FPFD patients was （57.9±13.9） （24-89） years and the mean disease course was （7.0±8.2） （0.5-40.0） years. Seventy-five cases （75%） were complicated with anal pain, 70 with urinary incontinence, 37 with rectocele, 19 with nocturia, 11 with urinary frequency, 10 with defecation incontinence. Complication with only one symptom was observed in 20 cases （20%）, and with two or more symptoms was observed in 80 cases （80%）. Pelvic floor relaxation syndrome patients were dominant （58 cases, 58%）. The severity of constipation （CSS） was 6-22 （13.89±3.79） points and the quality of life （PAC-QOL） was 45-133 （87.13±18.57） points in FPFD patients. VAS and SF-36 of patients combined with chronic functional anal rectal pain were 1-8 （3.0±1.9） points and 14.4-137.0 （71.5±31.4） points respectively. ICIQ-SF and I-QOL of patients combined with urinary incontinence were 1-17 （6.1±3.6） points and 52-110 （90.0±15.8） points respectively. Wexner-FIS and FI-QOL of patients combined with fecal incontinence were 1-11 （4.4±3.0） points and 52-116 （83.4±23.3） points respectively. Conclusions The symptoms of FPFD patients with constipation as chief complaint are complex. They are mainly complicated with anal diseases, then urinary incontinence, and mostly with more than 2 symptoms. Their quality of life is poor.