老年女性盆底修复手术疗效及术后新发尿失禁危险因素分析

Efficacy of pelvic floor repair surgery in elderly women and risk factors for postoperative de novo urinary incontinence

摘要

目的 探讨自体组织修复（NTR）和网片修复手术治疗老年盆腔脏器脱垂（POP）患者的疗效和安全性，并探讨术后新发尿失禁的潜在危险因素。方法 回顾性分析2015年1月1日-2019年12月31日于北京协和医院妇科行POP手术的241例年龄≥60岁、POP量化评分系统（POP-Q）分度Ⅱ度及以上的老年女性患者临床资料。采用倾向性评分匹配（PSM）法以均衡组间差异，比较匹配前后 NTR 组（135例）和网片修复组（106例）患者的临床相关指标。采用单因素及多因素logistic回归分析术后新发压力性尿失禁（SUI）和术后新发急迫性尿失禁（UUI）的危险因素。结果 匹配后，网片修复组患者的术后住院总时长、术中出血量和术后48 h内体温升高≥38 ℃的发生率均高于 NTR 组（P＜0.05）。术后随访1年，两组患者的主观满意率（90.91%对比89.39%）、主观治愈率（89.39% 对比86.36%）及慢性盆腔疼痛发生率（28.79% 对比25.76%）比较，差异均无统计学意义（P＞0.05）。术前 Aa值是术后新发SUI的独立危险因素（OR=1.91，95%CI:1.07～3.39，P=0.028），而术中网片修复被视为保护因素（OR=0.05，95%CI:0～0.56，P=0.015）。术后新发 UUI的危险因素是术前合并SUI（OR=2.73，95%CI:1.07～6.95，P=0.035）。结论 NTR 与网片修复手术治疗老年POP患者主观疗效相当。术前 Aa值升高是POP术后新发SUI的危险因素，术中网片修复为保护因素;术前存在SUI是POP术后新发 UUI的危险因素。

Abstract

Objective To compare the safety and efficacy of native tissue repair（NTR）and mesh repair surgery in elderly patients with pelvic organ prolapse（POP），and to explore the influencing factors of postoperative de novo urinary incontinence. Methods Clinical data of 241 elderly women（aged ≥60 years） with POP-Q stage ≥Ⅱ who underwent POP surgery in our hospital during Jan.1，2015 and Dec.31，2019 were retrospectively analyzed.Propensity score matching（PSM）was employed to balance differences between groups，and clinical characteristics were compared before and after matching between the NTR group（n=135）and mesh repair group（n=106）.Univariate and multivariate logistic regression analysis were performed to identify the risk factors of de novo stress urinary incontinence （SUI）and de novo urgency urinary incontinence（UUI）postoperatively. Results The mesh repair group had significantly longer postoperative hospital stay，greater intraoperative blood loss，and a higher incidence of fever （≥38 ℃） within 48 hours post-surgery compared to the NTR group after PSM（P＜0.05）.At 1-year postoperative follow-up，there were no statistically significant differences between the NTR group and mesh repair group in subjective satisfaction rate（90.91% vs. 89.39%），subjective cure rate（89.39% vs. 86.36%） and incidence of chronic pelvic pain（28.79% vs.25.76%）.Preoperative Aa was identified as an independent risk for postoperative de novo SUI（OR=1.91，95%CI:1.07-3.39，P=0.028），while mesh repair was a protective factor（OR=0.05，95%CI:0-0.56，P=0.015）.Preoperative SUI was independently associated with de novo UUI（OR=2.73，95%CI:1.07-6.95，P=0.035）. Conclusion NTR and mesh repair surgery have comparable efficacy in elderly patients with POP.Elevated preoperative Aa is associated with an increased risk of postoperative de novo SUI，whereas the use of mesh correlates with a reduced risk.Finally，preoperative SUI is related to de novo UUI.

关键词

盆腔脏器脱垂 / 尿失禁 / 自体组织修复 / 网片修复 / 危险因素

Key words

pelvic organ prolapse / urinary incontinence / native tissue repair / mesh repair / risk factors

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基金资助

国家自然科学基金项目(62476288)

国家临床重点专科建设项目(U114000)

北京市自然科学基金项目(L232124)

交叉融合非共识创新项目(F262040)

首都卫生发展科研专项项目(2024-2-4014)