發(fā)布時間：2018-05-16 08:04

  本文選題：盆底重建術(shù) + 盆腔器官脫垂��； 參考：《福建醫(yī)科大學(xué)》2014年碩士論文

【摘要】：【目的】 通過尿動力學(xué)檢查方法對盆腔器官脫垂（pelvic organ prolapse，POP）患者的膀胱尿道功能進行評估，結(jié)合泌尿生殖道癥狀問卷（Urinary DistressInventory-6，UDI-6）患者自評，探討POP患者下尿路功能情況；并比較經(jīng)陰道植入網(wǎng)片的盆底重建術(shù)（transvaginal placement of surgical mesh for pelvic organand prolapse，TVM）手術(shù)前后患者的尿動力學(xué)參數(shù)及問卷評分的變化，進一步研究TVM術(shù)對POP患者下尿路功能的影響，為后期POP合并顯性或隱匿性尿失禁的臨床治療提供新的思路和依據(jù)。 【方法】 1、第一部分盆底器官脫垂患者下尿路功能的研究 選取60例盆腔器官脫垂患者，通過尿動力學(xué)檢查及患者使用UDI-6主觀評估自身的下尿路癥狀，綜合評估POP患者下尿路功能。 2、第二部分盆底重建手術(shù)對盆底器官脫垂患者下尿路功能的影響 選取30例中重度盆腔器官脫垂患者于術(shù)前、術(shù)后3個月分別用尿動力學(xué)檢查方法檢測其初始排尿感膀胱容量（VFD）、常態(tài)排尿欲膀胱容量（VND）、強烈排尿感膀胱容量（VSD）、最大膀胱容量（MCC）、最大尿流率（Qmax）、排尿后膀胱殘余尿量（PVR）、最大尿道壓力（MUP）、最大尿道閉合壓（MUCP）、功能性尿道長度（FUL）等相關(guān)參數(shù)，如檢查中發(fā)現(xiàn)合并有壓力性尿失禁，則記錄腹壓漏尿點壓（ALPP）值；并同時在術(shù)前、術(shù)后3個月，通過患者使用UDI-6獲得下尿路癥狀的主觀評分。利用統(tǒng)計軟件SPSS16.0進行數(shù)據(jù)統(tǒng)計分析，計數(shù)資料采用χ2檢驗，對手術(shù)前后尿動力學(xué)相關(guān)參數(shù)的比較采用配對t檢驗，P值＜0.05則認(rèn)為所檢驗的差別有統(tǒng)計意義。借此，探討TVM術(shù)對中重度POP患者下尿路功能的影響。 【結(jié)果】 1、60例POP患者Ⅲ度18例，Ⅳ度42例。98.33%的患者合并有下尿路癥狀，經(jīng)臨床癥狀分析診斷為SUI、UUI、MUI、排尿功能障礙、尿頻，分別占6.67%、5%、11.67%、33.33%、41.67%；而尿動力學(xué)檢查診斷為USUI、DO、MUI和排尿功能障礙，各占38.33%、11.67%、10%、36.67%。雖然兩者的診斷結(jié)果存在一致性（P=0.005），但其一致性較差（Kappa值=0.310）。 56例POP患者行自由尿流率檢測時尿峰值流率為16.35±4.46ml/s，其中，有8例患者尿流率偏低（Qmax≤10ml/s），，16例患者PVR≥50ml。POP組和POP合并USUI組相比較，前者膀胱感覺容量稍大，MUP、MUCP壓力值略高，但差別無明顯的統(tǒng)計學(xué)意義（P＞0.05），而后者FUL明顯縮短，差異有統(tǒng)計學(xué)意義（P＜0.05）。 2、30例POP患者經(jīng)TVM手術(shù)治療，短期解剖治愈率達(dá)100%，隨訪中未發(fā)現(xiàn)嚴(yán)重并發(fā)癥。術(shù)后3個月患者UDI-6評分平均值較術(shù)前明顯降低，經(jīng)統(tǒng)計分析具有顯著差異（P＜0.05），泌尿生殖道癥狀明顯減輕，生活質(zhì)量改善情況好�；颊咝g(shù)后下尿路癥狀的發(fā)生率明顯降低（P＜0.05），排尿功能障礙及尿頻的癥狀得到明顯改善（P＜0.05），而尿急、SUI和MUI的癥狀在手術(shù)前后無顯著性差異（P＞0.05）。 行自由尿流率檢查，1例POP患者患有嚴(yán)重的UUI，無法憋尿完成自然狀態(tài)下尿流率測定，29例患者術(shù)后Qmax較術(shù)前明顯增高，經(jīng)統(tǒng)計學(xué)分析有顯著差異（P＜0.05）。術(shù)前檢查發(fā)現(xiàn)有6例尿潴留（PVR≥50ml），而術(shù)后均無一例發(fā)生。膀胱尿道功能檢測結(jié)果，術(shù)后VFD、VND、VSD、MCC均較術(shù)前明顯減小，其差異有統(tǒng)計學(xué)意義（P＜0.05）；MUP、MUCP升高，F(xiàn)UL延長，但差異無顯著的統(tǒng)計學(xué)意義（P＞0.05）。 【結(jié)論】 1、尿動力學(xué)檢查，結(jié)合UDI-6患者自評，可以綜合反映POP患者的下尿路功能情況，對合并下尿路功能障礙的診治有重要意義； 2、TVM術(shù)是治療POP的有效手段，手術(shù)解剖復(fù)位佳，患者的主觀脫垂癥狀、下尿路癥狀的總體情況得到明顯改善； 3、建議POP患者手術(shù)前均應(yīng)行尿動力學(xué)檢查以明確其下尿路功能情況； 4、TVM術(shù)在治療中重度POP的同時，對合并輕中度的尿失禁者亦有很好的預(yù)防和治療作用。
[Abstract]:[Objective]
The urinary bladder and urethra function of patients with pelvic organ prolapse (POP) was evaluated by urodynamic examination, and the function of lower urinary tract in POP patients was evaluated by self evaluation of the urogenital symptom questionnaire (Urinary DistressInventory-6, UDI-6), and the pelvic floor reconstruction by transvaginal mesh (transvaginal) was compared. Placement of surgical mesh for pelvic organand prolapse, TVM) changes in urodynamic parameters and questionnaire scores of patients before and after operation, and further study the effect of TVM on the urinary tract function of POP patients, and provide new ideas and basis for the clinical treatment of later POP with dominant or occult incontinence.
[method]
1. Part one study of lower urinary tract function in patients with pelvic organ prolapse
60 cases of pelvic organ prolapse were selected to evaluate the lower urinary tract function of POP patients through urodynamic examination and the patients' subjective assessment of their own lower urinary tract symptoms using UDI-6.
Effect of 2 and second parts of pelvic floor reconstruction on lower urinary tract function in patients with pelvic organ prolapse
30 cases of moderate and severe pelvic organ prolapse were selected before the operation, and 3 months after operation, the urinary bladder capacity (VFD), urinary bladder capacity (VND), strong urination bladder capacity (VSD), maximum bladder capacity (MCC), maximum urinary flow rate (Qmax), urinary bladder residual urine volume (PVR), maximum urethra after urination were measured. Pressure (MUP), maximum urethral closure pressure (MUCP), functional urethral length (FUL) and other related parameters, such as the detection of pressure urinary incontinence in the examination, recorded the point pressure (ALPP) of the abdominal pressure leaking urine (ALPP); and at the same time, 3 months after the operation, the subjective score of the symptoms of the lower urinary tract was obtained by the use of UDI-6. The statistics software SPSS16.0 was used to carry out the data. Statistical analysis, the count data were tested by the x 2 test. The paired t test was used to compare the parameters of the urodynamic parameters before and after the operation, and the value of P was less than 0.05, and the difference was statistically significant. Therefore, the effect of TVM on the lower urinary tract function of the patients with moderate and severe POP was discussed.
[results]
1,60 cases of POP patients were 18 cases, and 42 cases of IV degree.98.33% were combined with lower urinary tract symptoms. The clinical symptoms were diagnosed as SUI, UUI, MUI, urination dysfunction, frequency of urination, respectively 6.67%, 5%, 11.67%, 33.33%, 41.67%, while urodynamic examination was diagnosed as USUI, DO, MUI, and micturition dysfunction, each accounted for 38.33%, 11.67%, 10%, 36.67%. although they were 38.33%, 11.67%, 10%, 36.67%. although both were 38.33%. The diagnostic results were consistent (P=0.005), but their consistency was poor (Kappa =0.310).
The urine peak flow rate of 56 patients with POP was 16.35 + 4.46ml/s, of which 8 cases had lower urinary flow rate (Qmax < 10ml/s). 16 patients with PVR > 50ml.POP group and POP combined USUI group, the former bladder sensory capacity was slightly larger, MUP, MUCP pressure was slightly higher, but there was no significant difference (P > 0.05), and the latter FUL. The difference was statistically significant (P < 0.05).
2,30 patients with POP were treated with TVM operation, the short-term anatomical cure rate was 100%. No serious complications were found during the follow-up. The mean value of UDI-6 score was significantly lower than that before operation. The statistical analysis had significant difference (P < 0.05). The symptoms of genitourinary tract were obviously alleviated and the quality of life improved. The symptoms of lower urinary tract after operation were found. The birth rate was significantly lower (P < 0.05). The symptoms of urination dysfunction and frequency of urination were obviously improved (P < 0.05), while the symptoms of SUI and MUI were not significant before and after operation (P > 0.05).
In 1 cases of POP patients with severe UUI, the urine flow rate was detected in the natural state of the patients with severe UUI. The postoperative Qmax was significantly higher than before the operation (P < 0.05). The preoperative examination revealed that there were urinary retention (PVR > 50ml), and none of them occurred after the operation. The urinary bladder urethral function test results were found. After operation, VFD, VND, VSD and MCC were significantly lower than those before operation, and the difference was statistically significant (P < 0.05); MUP, MUCP increased, FUL prolonged, but the difference was not statistically significant (P > 0.05).
[Conclusion]
1, urodynamic examination, combined with the self evaluation of UDI-6 patients, can comprehensively reflect the lower urinary tract function of POP patients, which is of great significance for the diagnosis and treatment of the dysfunction of the lower urinary tract.
2, TVM is an effective way to treat POP. Surgical anatomy and reduction are better. The subjective prolapse symptoms and lower urinary tract symptoms of patients are improved significantly.
3, it is suggested that POP patients should perform urodynamic examination before operation to identify their lower urinary tract function.
4, TVM in the treatment of moderate and severe POP, at the same time, combined with mild to moderate urinary incontinence also has a good preventive and therapeutic effect.

【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R713

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相關(guān)期刊論文 前3條

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本文編號：1896091