子宫切除术对盆底功能障碍的影响：一项纵向研究。

Effects of Hysterectomy on Pelvic Floor Disorders: A Longitudinal Study.

作者信息

Kocaay Akin Firat, Oztuna Derya, Su Filiz Akin, Elhan Atilla Halil, Kuzu Mehmet Ayhan

机构信息

1Department of Surgery, Ankara University, Ankara, Turkey 2Department of Biostatistics, Ankara University, Ankara, Turkey 3Department of Obstetrics and Gynecology, Dr Zekai Tahir Burak Women Health Research and Education Hospital, Ankara, Turkey.

出版信息

Dis Colon Rectum. 2017 Mar;60(3):303-310. doi: 10.1097/DCR.0000000000000786.

DOI:10.1097/DCR.0000000000000786

PMID:28177993

Abstract

BACKGROUND

Hysterectomy might adversely affect pelvic floor functions and result in many different symptoms, such as urinary and anal incontinence, obstructed defecation, and constipation.

OBJECTIVE

The aim of this prospective study was to evaluate the influence of hysterectomy on pelvic floor disorders.

DESIGN

This was a prospective and longitudinal study.

SETTINGS

The study was conducted at the Ankara University Department of Surgery and the Dr Zekai Tahir Burak Women's Health Research and Education Hospital between September 2008 and March 2011.

PATIENTS

The study was performed on patients who underwent hysterectomy for benign pathologies.

MAIN OUTCOME MEASURES

A questionnaire about urinary incontinence (International Continence Society scoring), anal incontinence, constipation, and obstructed defecation (Rome criteria and constipation severity score), along with an extensive obstetric history, was administered preoperatively and postoperatively annually for 4 years.

RESULTS

Patients (N = 327) who had completed each of the 4 annual postoperative follow-ups were included in this study. Compared with the preoperative observations, the occurrence of each symptom was significantly increased at each of the follow-up years (p < 0.001). Over the 4 postoperative years, the frequencies for constipation (n = 245) were 7.8%, 8.2%, 8.6%, and 5.3%; those for obstructed defecation (n = 269) were 4.5%, 5.2%, 4.1%, and 3.0%; those for anal incontinence (n = 252) were 4.8%, 6.3%, 6.0%, and 5.2%, and those for urinary incontinence (n = 99) were 12.1%, 12.1%, 11.1%, and 13.1%. In addition, patients who had no preoperative symptom (n = 70) from any of the selected symptoms showed a postoperative occurrence of at least 1 of these symptoms of 15.8%, 14.3%, 11.4%, and 8.6% for the postoperative years 1, 2, 3, and 4.

LIMITATIONS

Although the study had several limitations, no comparison with a control population was the most important one.

CONCLUSIONS

Hysterectomy for benign gynecologic pathologies had a significant negative impact on pelvic floor functions in patients who had no previous symptoms.

摘要

背景

子宫切除术可能会对盆底功能产生不利影响，并导致许多不同的症状，如尿失禁和肛门失禁、排便梗阻及便秘。

目的

这项前瞻性研究的目的是评估子宫切除术对盆底功能障碍的影响。

设计

这是一项前瞻性纵向研究。

地点

该研究于2008年9月至2011年3月在安卡拉大学外科和泽凯·塔希尔·布拉克博士妇女健康研究与教育医院进行。

患者

该研究针对因良性病变接受子宫切除术的患者开展。

主要观察指标

术前及术后每年进行为期4年的问卷调查，内容包括尿失禁（国际尿失禁学会评分）、肛门失禁、便秘及排便梗阻（罗马标准和便秘严重程度评分），以及详细的产科病史。

结果

本研究纳入了完成术后4年每年随访的患者（N = 327）。与术前观察结果相比，各随访年份中每种症状的发生率均显著增加（p < 0.001）。术后4年中，便秘（n = 245）的发生率分别为7.8%、8.2%、8.6%和5.3%；排便梗阻（n = 269）的发生率分别为4.5%、5.2%、4.1%和3.0%；肛门失禁（n = 252）的发生率分别为4.8%、6.3%、6.0%和5.2%；尿失禁（n = 99）的发生率分别为12.1%、12.1%、11.1%和13.1%。此外，术前无任何所选症状（n = 70）的患者在术后第1、2、3和4年出现至少1种这些症状的发生率分别为15.8%、14.3%、11.4%和8.6%。