盆腔器官脱垂定量分期法中前后壁B点与A点差值的临床意义研究

A study on the clinical significance of the difference between point B and point A of front and back wall in pelvic organ prolapse quantification system

目的研究盆腔器官脱垂定量分期法(POP-Q)中B点和A点差值与排尿及排便异常的相关性,探讨Aa、Ap在盆腔器官脱垂评估中的不可替代性。方法检索北京大学人民医院妇科2012年2月至2019年8月因盆腔器官脱垂行手术治疗的病例资料,术前POP-Q分期Ⅲ~Ⅳ期,最终符合标准的患者共计254例。收集患者一般情况、术前POP-Q评分及临床症状,包括压力性尿失禁、急迫性尿失禁、排尿困难、粪失禁及排便困难5项内容,分别定义为患者主诉超过一半频率的排尿或排便异常。结果POP-Q测量结果中,Ba-Aa、Bp-Ap与3个腔室脱垂分期的指示点Ba、C、Bp均显著相关(r=0.636,P<0.001;r=0.587,P<0.001;r=0.407,P<0.001;r=0.405,P<0.001;r=0.541,P<0.001;r=0.670,P<0.001)。压力性尿失禁的患者Ba-Aa值[(1.30±1.27)cm]较无压力性尿失禁的患者[(1.73±1.30)cm]更小(P=0.016);排尿困难的患者Ba-Aa值[(2.01±1.35)cm]较无排尿困难的患者[(1.43±1.25)cm]更大(P=0.001);是否急迫性尿失禁Ba-Aa结果差异无统计学意义(P=0.067);是否排便困难Bp-Ap结果差异无统计学意义(P=0.097)。结论Ba-Aa、Bp-Ap与前中后盆腔脱垂严重程度相关性显著,Ba-Aa与压力性尿失禁、排尿困难症状有关。Aa、Ap、Ba、Bp的测量能够在一定意义上反映前后壁脱垂解剖与功能特征,均具有不可取代的意义。

Objective To study the correlation between the Ba-Aa/Bp-Ap and urination and defecation dysfunction,and to explore the irreplaceability of Aa and Ap in the evaluation of pelvic organ prolapse.MethodsPatients whounderwent surgery for pelvic organ prolapse from February 2012 to August 2019 in Peking University People’s Hospitalwere retrieved.To collecting the information of 254 patients who met the criteria,such as the general information andpreoperative POP-Q examination results and preoperative clinical symptoms,including stress urinary incontinence,urgent urinary incontinence,dysuria,fecal incontinence,and constipation,which was defined as patients who complainedthat they had abnormal urination or defecation more than half of the time.ResultsThe Ba-Aa and Bp-Ap hadsignificant correlation with Ba,C,and Bp(r=0.636,P<0.001;r=0.587,P<0.001;r=0.407,P<0.001;r=0.405,P<0.001;r=0.541,P<0.001;r=0.670,P<0.001).Ba-Aa in patients with stress urinary incontinence[(1.30±1.27)cm]were smaller than in patients without stress urinary incontinence[(1.73±1.30)cm,P=0.016].Ba-Aa in patients withdysuria[(2.01±1.35)cm]was greater than that in patients without urinary dysuria[(1.43±1.25)cm,P=0.001].There wasno significant difference in Ba-Aa for patients with or without urgent incontinence(P=0.067).There was no significant difference in the results of Bp-Ap in patients with orwithout defecation difficulty(P=0.097).Conclusions Ba-Aa and Bp-Ap are significantly related to theseverity of anterior,middle,and posterior pelvic prolapse,and Ba-Aa is associated with symptoms of stress urinaryincontinence and dysuria.The measurement of Aa,Ap,Ba,and Bp can reflect the anatomical and functional characteristics of anterior and posterior prolapse to a certain degree.So,the examination of Aa and Ap is irreplaceable.