全子宫切除术对子宫肌瘤患者下尿路症状影响的前瞻性研究

Change in lower urinary tract symptoms after surgical treatment of uterine leiomyoma: A prospective study

目的通过子宫肌瘤患者全子宫切除术前、术后下尿路症状的变化情况,探讨全子宫切除术对子宫肌瘤患者下尿路症状影响。方法收集2012年6月至2015年6月北京大学人民医院因子宫异常出血或月经量改变行全子宫切除术后病理结果证实为子宫平滑肌瘤患者169例。参考Bristol女性下尿路症状及对生活质量影响的调查问卷,调查患者术前及术后3个月下尿路症状情况。结果 （1）169例子宫肌瘤患者中,术前贮尿期症状的患病率为53.8%（91/169）,术后贮尿期症状的患病率为57.4%（97/169）;手术前后尿频、尿急、夜尿增多、压力性和急迫性尿失禁等症状的患病率比较,差异均无统计学意义（P〉0.05）;（2）169例子宫肌瘤患者术前排尿症状的患病率为16.0%（27/169）,术后为57.4%（97/169）;（3）169例子宫肌瘤患者术前尿频（32.0%,54/169）、尿急（10.7%,18/169）、夜尿增多症状（21.9%,37/169）,术后3个月超过50%改善或消失,术前压力性尿失禁症状（33.3%,35/105）在术后（25.7%,9/35）改善或消失;（4）169例子宫肌瘤患者术前贮尿期症状阳性的患者子宫体积（168.38±83.59）cm^3大于无贮尿期症状患者（120.98±76.61）cm^3（P=0.027）。结论全子宫切除术对子宫肌瘤患者下尿路症状的患病率无明显影响。术前存在的尿频、尿急、夜尿增多症状术后改善明显。子宫体积可能为子宫肌瘤患者贮尿期症状的影响因素。

Objective To investigate the effect of total hysterectomy on lower urinary tract symptoms in patients with uterine fibroids. Methods From June 2012 to June 2015, Patients who underwent total hysterectomy due to abnormal uterine bleeding or changes in menstrual volume in Peking University People＇s hospital were enrolled into this study. 169 cases were pathological confirmed as uterine leiomyoma. The lower urinary tract symptoms before and 3 months after operation were investigated according to Bristol female lower urinary tract symptoms questionnaire. Results（1） Among 169 cases with uterine leiomyoma,the prevalence rate of storage symptoms before surgery was 53.8%（91/169）, the prevalence rate after surgery was 57.4%（97/169）. There is no significant change in the prevalence of frequency, nocturia, urgency, and urinary incontinence before and after the hysterectomy（P〈0.05）.（2） Among 169 cases with uterine leiomyoma, the voiding symptoms before surgery was 16.0%（27/169）, the prevalence rate after surgery was 13.6%（23/169）.（3） The preexisting Frequency（32.0%, 54/169）,urgency（10.7%, 18/169） and nocturia（21.9%, 37/169） were regress or disappear in more than 50% patients. However, only 25.7%（9/35） preexisting stressed urinary incontinence were regress of disappear.（4） Compared with the control group,the group with storage symptoms had larger uterus（168.38 cm^3 vs 120.98 cm^3, P = 0.027）. Conclutions The prevalence rate of LUTS among patients with uterine leiomyoma was not significant change before and after the hysterectomy. The preexisting frequency, urgency and nocturia were significant improved after hysterectomy. The volume of the uterus might be the factor of LUTS.