保留与切除子宫对绝经期子宫脱垂患者盆底肌电性激素尿动力学参数的影响

The Effect of Preservation Versus Removal of the Uterus on Pelvic Floor Electromyography Sex Hormones and Urodynamic Parameters in Patients with Menopausal Uterine Prolapse

目的:探讨保留与切除子宫对绝经期子宫脱垂(UP)患者盆底肌电、性激素、尿动力学参数的影响。方法:回顾性选取2015年5月至2019年5月我院100例绝经期UP患者,根据手术方案分为切除子宫组(n=50)和保留子宫组(n=50),分别施行阴式子宫切除术(VH)+阴道前后壁修补术、单纯阴道前后壁修补术。观察两组围术期指标、并发症、复发率及术前、术后1个月盆底肌电(快速收缩、紧张收缩值、耐力测试值)、性激素指标[雌二醇(E2)、促黄体生成素(LH)、卵泡刺激素(FSH)]、尿动力学参数[最大尿道闭合压(MUCP)、腹压漏尿点压(ALPP)、最大尿道压(MUP)]。结果:切除子宫组手术时间长于保留子宫组(P<0.05),两组术中出血量、住院时间、下床活动时间比较,无显著差异(P>0.05);术后1个月切除子宫组紧张收缩值、快速收缩、耐力测试值高于保留子宫组(P<0.05);术后1个月切除子宫组E2水平低于保留子宫组,LH、FSH水平高于保留子宫组(P<0.05);术后1个月切除子宫组MUCP、ALPP、MUP高于保留子宫组(P<0.05);两组并发症发生率比较,无显著差异(P>0.05);术后随访12个月,切除子宫组复发率低于保留子宫组(P<0.05)。结论:单纯阴道前后壁修补术、VH联合阴道前后壁修补术治疗绝经期UP患者,在手术创伤、术后恢复方面效果相当,而联合手术可改善盆底肌电、尿动力学参数,降低复发率,但可对性激素水平产生一定影响。

Objective:To explore the effects of uterine preservation and removal on pelvic floor electromyography,sex hormones and urodynamic parameters in patients with menopausal uterine prolapse.Methods:A total of 100 patients with menopausal uterine prolapse in our hospital from May 2015 to May 2019 were selected and divided into uterine removal group(n=50)and uterine preservation group(n=50)according to the surgical regimens.Vaginal hysterectomy+anterior and posterior vaginal wall repair and simple anterior and posterior vaginal wall repair were performed respectively.Clinical data were observed including the perioperative indicators,complications,recurrence rate and pelvic floor electromyography(rapid contraction,tension contraction value,endurance test value),sex hormone indicators[estradiol(E2),luteinizing hormone(LH),follicle stimulating hormone(FSH)],urodynamic parameters[maximum urethral closure pressure(MUCP),abdominal pressure leaking urine point pressure(ALPP),maximum urethral pressure(MUP)]before and 1 month after operation in the two groups.Results:The operation time of the uterine removal group was longer than that of the uterine preservation group(P<0.05).There was no significant difference in the amount of blood loss,hospital stay,and time to get out of bed between the two groups(P>0.05);one month after operation,the values of tension contraction,rapid contraction and endurance in the uterine removal group were higher than those in the uterine preservation group(P<0.05);one month after operation,the E2 level of the uterine removal group was lower than that of the uterine preservation group,and the levels of LH and FSH were higher than that of the uterine preservation group(P<0.05);the MUCP,ALPP and MUP of the uterine removal group were higher than those of the uterine preservation group at 1 month after operation(P<0.05);there was no significant difference in the incidence of complications between the two groups(P>0.05);after 12 months of follow-up,the recurrence rate of the uterine removal group was lower than that of the uterine preservation group(P<0.05).Conclusion:Simple anterior and posterior vaginal wall repair,vaginal hysterectomy combined with anterior and posterior vaginal wall repair in the treatment of menopausal uterine prolapse patients have equivalent effects in surgical trauma and postoperative recovery.Combined surgery can improve pelvic floor electromyography and urodynamic parameters,and reduce the recurrence rate,but it can have a certain impact on sex hormone levels.