益气升提法改善全宫术后盆底功能的研究

Study on the Improvement of Pelvic Floor Function after Total Hysterectomy by Yiqi Shengti Method

目的:观察盆底肌肉训练、中医益气升提法及两者联合运用对全子宫切除术(Total Hysterectomy,TH)术后患者盆底功能的作用。方法:选择我科住院非脱垂TH患者124例为研究对象,随机分为四组:空白对照组(A组)、锻练组(B组)、中医组(C组)及联合组(D组)。A组常规随访,B组进行盆底肌肉锻炼,C组运用益气升提法:内服补中益气丸+穴位艾灸(气海、关元、百会穴),D组进行盆底肌肉锻炼及益气升提法,最终通过术前、术后每3月共12个月进行关于压力性尿失禁及盆底功能的妇科一泌尿病例问卷调查,并进行盆底肌肉肌力测定和POP-Q分度、性功能障碍诊断量表及评分表进行比较分析,从尿失禁、阴道顶端脱垂、盆底肌肉肌力、性功能等方面客观评价上述方法对TH术后女性盆底功能的作用。结果:四组患者术后随访1年,仅1例发生压力性尿失禁,发生率为0.81%。阴道前后壁Aa、Ap、Ba、Bp点在A组呈进行性下降趋势,术后与术前比较差异有统计学意义(P <0.05),在B、C、D组各点术后与术前比较差异无统计学意义(P> 0.05);组间比较:B组与D组对于预防各点下降效果相当(P> 0.05),优于C组(P <0.05)。C点测量值在A组及B组中随时间延长而降低,A组在术后3、6、9、12个月及B组在术后6、9、12个月与术前比较,差异有统计学意义(P <0.05),C、D组术后3、6、9、12个月与术前比较,差异无统计学意义(P> 0.05);组间比较:D组优于C组(P <0.05)。盆底肌肉肌力在A组呈进行性下降趋势,术后3、6、9、12个月与术前比较,差异有统计学意义(P <0.05);C组在术后9、12个月与术前比较,差异无统计学意义(P> 0.05),B组及D组在术后9、12个月与术前比较有提高,差异均有统计学意义(P <0.05);组间比较:D组效果优于B组(P <0.05)。性生活评分在A组呈进行性下降趋势,术后3、6、9、12个月与术前比较,差异有统计学意义(P <0.05),B组在术后12个月与术前比较,差异无统计学意义(P> 0.05);C组在术后12个月及D组在术后9、12个月较术前性生活评分提高,差异有统计学意义(P <0.05);组间比较:D组效果优于C组(P <0.05)。结论:TH对女性盆底功能的近期影响是引起阴道松弛、降低盆底肌肉肌力及性生活质量。术后早期给予积极干预措施,如盆底肌肉锻炼及益气升提中医疗法,或两者联合可以减少或延缓TH术后盆底功能障碍性疾病的发生,是简便效廉、易于掌握、值得临床推广的方法。

Objective: To observe the effects of pelvic floor muscle training, traditional Chinese medicine yiqi shengti method and the combination of the two methods on pelvic floor function after total hysterectomy(TH). Methods: In the study, 124 cases of patients with non-prolapse uterus TH in my department were selected as the study subjects and were randomly divided into 4 groups: the blank control group(group A), the exercise group(group B), the Chinese medicine group(group C) and the combined treatment group(group D). Group A was routinely followed up. Group B exercised pelvic floor muscles. Group C adopted yiqi shengti method: the combination of oral administration of Buzhong Yiqi Pills with acupoint moxibustion(Qihai(CV6), Guanyuan(CV4) and Baihui(GV20)). Group D performed pelvic floor muscle training combined with Yiqi Shengti method. Finally, through the preoperative and postoperative every 3 months for a total of 12 months, a urinary cases of department of gynaecology questionnaire on stress urinary incontinence and pelvic floor function was conducted, and determination of pelvic floor muscle strength and POP-Q dividing, sexual dysfunction were performed to compare the diagnostic scale and scale analysis. The effects of the above methods on female pelvic floor function after TH were objectively evaluated from urinary incontinence, the top of vaginal prolapse, pelvic floor muscle strength, sexual function and so on. Results: In the 1 year follow-up among the 4 groups of patients, only 1 case of SUI occurred, and the incidence was 0.81%. The vaginal anterior and rear wall Aa, Ap, Ba and Bp points showed progressive decline in group A, and the difference was statistically significant before and after surgery(P < 0.05). There was no statistically significant difference in these points between the postoperative and postoperative in group B, C and D(P > 0.05). Comparison between groups: group B and group D had a similar effect on prevention of these points(P >0.05), which was better than group C(P < 0.05). The C point measurement was decreased with time in group A and group B. Group C and D 3, 6, 9, 12 months after operation compared with preoperative period, the difference was not statistically significant(P > 0.05). Comparison between groups: group D was superior to group C(P < 0.05). Pelvic floor muscle strength showed progressive decline in group A, 3, 6, 9, 12 months after surgery compared with preoperative period, and the difference was statistically significant(P < 0.05). There was no significant difference in group C between9 and 12 months after surgery(P > 0.05). Group B and group D were significantly improved after 9, 12 months after surgery, and the difference was statistically significant(P < 0.05). Comparison between groups: group D was better than group B(P < 0.05). Sex scores were declining in group A, and the difference was statistically significant(P < 0.05). In group B, there was no statistically significant difference between 12 months and preoperative period(P > 0.05). The sex scores of group C in the 12 months after the operation and group D in the 9 and 12 months after surgery were higher than that in the preoperative period, and the difference was statistically significant(P < 0.05). Comparison between groups:group D was better than group C(P < 0.05). Conclusion: The recent influence of TH on the pelvic floor function of women results in vaginal relaxation, reduction of pelvic floor muscle strength and sexual quality. Early postoperative intervention measures, such as pelvic floor muscle training and Yiqi Shengti of TCM, or the combination of the two methods can reduce or delay the occurrence of postoperative pelvic floor dysfunction disease. These methods are simple, easy to grasp,and worthy of clinical promotion.