Pong Joanna, Bohlin Katja Stenström, Pedroletti Corinne, Strandell Annika
The Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden,
Int Urogynecol J. 2015 Sep;26(9):1361-7. doi: 10.1007/s00192-015-2715-8. Epub 2015 May 5.
Surgery for pelvic organ prolapse (POP) under local anesthesia has been advocated for several reasons such as lower costs and application in multimorbid patients. The aim of this study was to investigate how the anesthetic method influences the rate of recurrent prolapse and patient satisfaction with POP surgery.
In this retrospective study 4,936 women operated for single-compartment prolapse between 2006 and 2011 were included from the Swedish National Register for Gynecological Surgery. The feeling of vaginal bulge 1 year after surgery indicated presence of recurrent prolapse. Multivariate logistic regression analyses were used to identify independent factors affecting the outcomes, presented as adjusted odds ratios (aOR) with 95 % confidence interval (CI).
After surgery for single-compartment prolapse patients with cystocele were at a higher risk of feeling a vaginal bulge than patients with rectocele (1.62, CI 1.28-2.06). Applied anesthesia was no independent predictor of bulge symptoms in the cystocele/rectocele population. In the cystocele group local anesthesia compared with general or regional anesthesia implied an increased risk of vaginal bulge symptoms (1.32, CI 1.03-1.68) as well as POP-Q-stage III-IV (1.30, CI 1.09-1.55), and a higher BMI class (1.22, CI 1.03-1.46), while a higher age class decreased the risk (0.79, CI 0.70-0.89). Choice of anesthesia had no impact on bulge symptoms in the rectocele group and no influence on patient satisfaction in any of the groups.
Patients operated for cystocele under local anesthesia were at a higher risk of experiencing vaginal bulge symptoms 1 year after surgery compared with general or regional anesthesia.
因成本较低以及适用于患有多种疾病的患者等多种原因，局部麻醉下的盆腔器官脱垂（POP）手术一直受到提倡。本研究的目的是调查麻醉方法如何影响复发脱垂率以及患者对POP手术的满意度。
在这项回顾性研究中，从瑞典国家妇科手术登记处纳入了2006年至2011年间接受单腔室脱垂手术的4936名女性。术后1年的阴道膨出感表明存在复发脱垂。采用多因素逻辑回归分析来确定影响结果的独立因素，以调整优势比（aOR）及95%置信区间（CI）表示。
单腔室脱垂手术后，膀胱膨出患者比直肠膨出患者出现阴道膨出感的风险更高（1.62，CI 1.28 - 2.06）。在膀胱膨出/直肠膨出人群中，所采用的麻醉方式并非膨出症状的独立预测因素。在膀胱膨出组中，与全身麻醉或区域麻醉相比，局部麻醉意味着出现阴道膨出症状的风险增加（1.32，CI 1.03 - 1.68）以及POP - Q分期为III - IV期的风险增加（1.30，CI 1.09 - 1.55），且体重指数（BMI）等级更高（1.22，CI 1.03 - 1.46），而年龄较大则降低了风险（0.79，CI 0.70 - 0.89）。麻醉方式的选择对直肠膨出组的膨出症状没有影响，对任何一组的患者满意度也没有影响。
与全身麻醉或区域麻醉相比，局部麻醉下接受膀胱膨出手术的患者术后1年出现阴道膨出症状的风险更高。
