盆腔器官脱垂患者手术疗效及影响因素分析

Surgical outcomes of pelvic organ prolapse and the influencing factors

目的分析盆腔器官脱垂患者手术疗效及影响。方法回顾性分析2019年2月至2022年2月治疗的150例盆腔器官脱垂患者。观察患者术前、术后症状改善情况、POP-Q分度、POP生活质量、尿潴留发生情况、治疗效果,分析盆腔器官脱垂患者治疗效果的影响因素。结果与术前相比,术后患者尿频、尿急、下腹坠痛发生率减少(P<0.05)。与术前相比,术后0期、Ⅰ期、Ⅱ期患者数量增加,Ⅲ期、Ⅳ期患者数量下降(P<0.05)。与术前相比,术后患者情绪、角色、脱垂严重程度、生活状况、体力、个人关系、社交、睡眠、健康状况评分降低(P<0.05)。手术后,发生尿潴留22例(14.67%),治疗效果良好患者130例(86.67%),治疗效果差20例(13.33%)。单因素分析显示,盆腔器官脱垂患者术后治疗效果差与高血压、糖尿病、产次、孕次、子宫是否保留、术后并发心率失常、学历、婚姻状况无关(P>0.05);年龄≥60岁、BMI≥25 kg/m^(2)、病程≥3年、脱垂部位为前盆腔、术后阴道壁长度≥5 cm、POP-Q术前分度为Ⅳ期、术后并发感染、发生尿潴留患者治疗效果差(P<0.05)。以盆腔器官脱垂患者术后治疗效果为因变量(治疗效果良好=0;治疗效果差=1),选择单因素分析中P<0.05的变量进行多因素Logistics回归分析,结果显示,年龄、BMI、病程、脱垂部位、术后阴道壁长度、POP-Q术前分度、术后并发感染、尿潴留发生情况为影响术后治疗效果的危险因素(P<0.05)。结论盆腔器官脱垂术后患者临床症状减轻,生活质量得到改善,盆腔器官脱垂减轻,且盆腔器官脱垂患者的术后治疗效果可受到年龄、BMI、病程、脱垂部位、术后阴道壁长度、POP-Q术前分期、术后并发感染、尿潴留发生情况的影响,根据影响因素对患者进行干预,可提高临床治疗效果。

Objective To analyze the surgical outcomes of pelvic organ prolapse(POP)and the influencing factors.Methods We retrospectively analyzed 150 POP patients who were treated in our hospital from February 2019 to February 2022.Preoperative symptoms,relief of postoperative symptoms,the Pelvic Organ Prolapse Quantification System(POP-Q),quality of life in POP,urinary retention and surgical outcome were observed.Influencing factors of surgical outcome of POP were analyzed.Results Compared with those of preoperative data,the incidences of postoperative frequent urination,urgency,and lower abdominal pain were significantly reduced in POP patients(P<0.05).Compared with those of preoperative data,the proportion of patients with postoperative POP-Q 0,Ⅰ°,andⅡ°significantly increased,while the proportion of patients with postoperative POP-QⅢ°andⅣ°significantly decreased(P<0.05).Compared with preoperative findings,scores of postoperative emotions,roles,severity of prolapse,living conditions,physical strength,personal relationships,social interaction,sleep quality,and health status were significantly reduced(P<0.05).Totally 22(14.67%)patients had postoperative urinary retention.A total of 130(86.67%)patients had a good treatment effect,and 20(13.33%)had a poor treatment effect.Univariate analysis showed that the poor surgical outcome in POP patients was not correlated with hypertension,diabetes,parity,pregnancy,uterus preservation,postoperative arrhythmia,education,and marital status(P>0.05).Age≥60 years,body mass index(BMI)≥25kg/m^(2),course of disease≥3 years,prolapse position of anterior pelvis,length of vaginal wall≥5cm,preoperative POP-QⅣ°,postoperative infection and urinary retention were significantly correlated with the poor surgical outcome of POP(P<0.05).Taking the postoperative outcome of POP as the dependent variable(good treatment effect=0;poor treatment effect=1),variables with significant differences in the univariate analysis were introduced into the multivariate logistic regression analysis.The results showed that age,BMI,course of disease,prolapse site,postoperative vaginal wall length,POP-Q preoperative graduation,postoperative infection,and urinary retention were the risk factors for the surgical outcome of POP(P<0.05).Conclusion Surgical procedures alleviate clinical symptoms of POP,improve the quality of life and reduce the degree of POP.The surgical outcome is influenced by age,BMI,course of disease,prolapse site,postoperative vaginal wall length,POP-Q preoperative grading,postoperative coinfection,and urinary retention.Targeted interventions based on the risk factors can improve the clinical treatment effect and promote the recovery.