Humalajärvi Niina, Aukee Pauliina, Kairaluoma Matti V, Stach-Lempinen Beata, Sintonen Harri, Valpas Antti, Heinonen Pentti K
Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland.
Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland.
Eur J Obstet Gynecol Reprod Biol. 2014 Nov;182:16-21. doi: 10.1016/j.ejogrb.2014.08.032. Epub 2014 Aug 30.
To assess the effect of hysterectomy with or without pelvic organ prolapse (POP) on health-related quality of life (HRQoL) and pelvic floor disorders.
Prospective clinical study at two central hospitals in Finland. During one year 322 women underwent elective hysterectomy for benign conditions with or without vaginal wall repair. The study population was divided in two groups, patients with and without POP. The HRQoL questionnaires RAND-36 and 15D, and questionnaires assessing urinary and bowel dysfunction symptoms were obtained preoperatively and 12 months postoperatively. POP was defined as the descent of apical, anterior or posterior compartment of vaginal wall grade ≥2 in the Baden-Walker classification at any site. Main outcome measures were HRQoL, improvement of symptoms and de novo symptoms.
At baseline the mean 15D score of all patients was lower than that of the age-standardized population sample (p<0.001). At one year postoperatively, the mean 15D score of the patients had improved (p=0.001), this resulting mainly on dimensions of excretion (voiding and defecation), usual activities, discomfort and symptom, distress, vitality and sexual activity. HRQoL improved especially in patients with POP. They reported improvement of symptoms in urinary incontinence, urinary frequency, constipation and sense of bulging but surgery had no effect on anal incontinence. Patients without POP reported improvement in pain dimension, urinary frequency and feeling of bulging. Urinary incontinence was the most common (15.4% and 13.8%) de novo symptom in both groups.
Hysterectomy with or without concomitant pelvic organ prolapse surgery improves health-related quality of life and reduces pelvic floor symptoms in one-year follow-up.
评估子宫切除术伴或不伴盆腔器官脱垂（POP）对健康相关生活质量（HRQoL）和盆底功能障碍的影响。
在芬兰两家中心医院进行的前瞻性临床研究。一年内，322名女性因良性疾病接受了选择性子宫切除术，伴或不伴阴道壁修补术。研究人群分为两组，有POP和无POP的患者。术前和术后12个月获取HRQoL问卷RAND-36和15D，以及评估泌尿和肠道功能障碍症状的问卷。POP定义为在任何部位，阴道壁顶端、前壁或后壁在巴登-沃克分类中分级≥2的下移。主要结局指标为HRQoL、症状改善情况和新发症状。
基线时，所有患者的平均15D评分低于年龄标准化人群样本（p<0.001）。术后一年，患者的平均15D评分有所改善（p=0.001），这主要体现在排泄（排尿和排便）、日常活动、不适与症状、困扰、活力和性活动等维度。HRQoL尤其在有POP的患者中得到改善。他们报告尿失禁、尿频、便秘和坠胀感等症状有所改善，但手术对肛门失禁无影响。无POP的患者报告疼痛维度、尿频和坠胀感有所改善。尿失禁是两组中最常见的新发症状（分别为15.4%和13.8%）。
子宫切除术伴或不伴盆腔器官脱垂手术在一年随访中可改善健康相关生活质量并减轻盆底症状。
