盆腔器官脱垂传统术式术后尿失禁的相关因素分析及围手术期中医药治疗探讨

Analysis of Related Factors of Urinary Incontinence after Traditional Operation for Pelvic Organ Prolapse and Preliminary Study of Perioperative Treatment with Traditional Chinese Medicine

【目的】分析围手术期盆腔器官脱垂(POP)患者行传统术式阴式全子宫切除+阴道壁修补术术后出现尿失禁的相关因素,并初步探讨其中医证型特点及中医药的治疗价值。【方法】回顾性分析2007~2017年在广东省中医院二沙分院行经阴道全子宫切除术+阴道壁修补术的51例成功随访患者及其病例资料,对可能引起术后尿失禁的相关因素进行统计学分析,并总结分析POP的中医证型、证素特点和围手术期中医治疗的治法方药。【结果】(1)51例POP患者行阴式全子宫切除联合阴道壁修补术后出现尿失禁者14例,占27.5%。(2)以术后尿失禁为因变量,纳入手术年龄、住院时间、子宫脱垂程度、阴道壁脱垂程度、手术时间、术前运用中药天数、高血压史、甲亢史、糖尿病史等因素,进行多元Logistic回归分析,结果显示术后出现尿失禁与子宫脱垂程度有关。(3)51例患者主要的中医证型为肾虚血瘀和肾虚证。中医病位证素主要有肾、脾、肝;病性证素主要有气虚、血瘀、湿、气陷等。(4)术前中医治疗主要以补气升提、健脾补肾为法,常用补中益气汤加减、六味地黄汤加减。【结论】子宫脱垂的程度越严重,患者术后出现尿失禁的可能性越大;POP患者术前的主要中医证型为肾虚血瘀证、肾虚证,但其围手术期结合中医药治疗的有效性尚有待进一步深入探讨。

Objective To analyze the related factors of urinary incontinence in patients with perioperative pelvic organ prolapse(POP)after traditional vaginal total hysterectomy plus vaginal wall repair, and to preliminarily explore the characteristics of traditional Chinese medicine(TCM)syndrome types and the therapeutic effect of TCM. Methods A retrospective analysis was performed for 51 successfully followed-up patients treated with transvaginal total hysterectomy plus vaginal wall repair in Guangdong Provincial Hospital of TCM Ersha Branch during 2007-2017. The clinical data of the patients were collected and then the statistical analysis of related factors that may cause postoperative urinary incontinence was performed. Meanwhile, the TCM syndrome types,syndrome element characteristics and TCM therapeutic methods and prescriptions in perioperative period of POP were summarized and analyzed. Results(1)Of the 51 POP patients who underwent transvaginal total hysterectomy plus vaginal wall repair,14 cases(27.5%)had urinary incontinence.(2)Multivariate Logistic regression analysis of operative age, hospitalization time, degree of uterine prolapse, degree of vaginal wall prolapse, operative time,days of preoperative medication of Chinese medicine,history of hypertension,history of hyperthyroidism,history of diabetes, etc. was conducted, and the results showed that the incidence of postoperative urinary incontinence was related to the degree of uterine prolapse.(3)The main TCM syndromes of 51 patients were kidney deficiency and blood stasis syndrome and kidney deficiency syndrome. The disease-location syndrome elements mainly involved kidney, spleen and liver. The disease-nature syndrome elements were predominated by qi deficiency,blood stasis,dampness,sinking of qi,etc.(4)Preoperative TCM treatment focused on replenishing and elevating qi,strengthening spleen and tonifying kidney by using Buzhong Yiqi Decoction and modified Liuwei Dihuang Decoction respectively. Conclusion The more severe the uterine prolapse,the higher the possibility of postoperative urinary incontinence. The main TCM syndrome types of POP patients before surgery are predominated by kidney deficiency and blood stasis syndrome and kidney deficiency syndrome, whereas the effectiveness of TCM treatment in perioperative period of POP needs to be further investigated.