摘要
目的探讨重度（Ⅲ～Ⅳ度）盆底器官脱垂（POP）患者Aa、Ba指示点对隐匿性压力性尿失禁（OSUI）的诊断及预后价值。方法回顾性分析于2007年1月至2012年9月在武汉大学人民医院因“POPⅢ-IV度”行全盆底重建手术的93例患者（术前均无显性尿失禁）的临床资料，其中，44例为POP合并OSUI者被纳入POP合并OSUI组，其余49例单纯POP患者纳入单纯POP组，并于术后3、6、12、24个月随访术后新发SUI情况，通过logistie回归分析术后新发SUI的危险因素，结合受试者工作特征（ROC）曲线分析盆腔器官脱垂定量（POP．Q）分度指标中Aa、Ba指示点对术前OSUI的诊断及预后价值。结果（1）POP合并OSUI组术后24个月新发SUI的发生率为30％（13／44），显著高于单纯POP组（4％，2／49），两组比较，差异有统计学意义（P〈0．01）。（2）logistic回归分析显示，阴道分娩次数（OR=5．327，95％CI为1．120～25．347）、慢性便秘（OR=5．789，95％CI为1．492—22．459）、术前合并OSUI（OR=13．695，95％CI为2．980～62．944）、阴道前壁膨出（OR=6．115，95％CI为1．231～30．379）是重度POP患者术后新发SUI的独立危险因素。（3）针对POP合并OSUI者，ROC曲线选取＋1．5cm为Aa指示点预测术后新发SUI的阈值，ROC曲线下面积为0．889（P〈0．05），敏感度为88．9％，特异度为73．9％；选择＋2．5am为Ba指示点预测OSUI术后新发SUI的阈值，ROC曲线下面积为0．766（P〈0．05），敏感度为66．7％，特异度为82．6％。结论重度POP患者术前合并OSUI是盆底重建手术后新发SUI的独立危险因素。术前Aa、Ba指示点与是否合并OSUI具有相关性，并在盆底重建手术后新发SUI的风险预测方面有一定价值。
Objective To investigate the correlation between pelvic organ prolapse quantitation （POP-Q） indication points and the incidence of occuh stress urinary incontinence （OSUI） and its impact on prognosis. Methods Retrospective study medical records of 93 patients with pelvic organ prolapse （POP） staged at Ⅲ- IV, of which underwent pelvic reconstruction operations with Prolift system from Jan. 2007 to Sept. 2012. None of these patients had clinical manifestations of stress urinary incontinence （SUI） before surgery, and in which 44 patients were included in study group （POP complicated with OSUI） because they were identified with OSUI, another 49 patients as control group （simple POP）. Follow-up and collecting datas including POP-Q, stress test, urodynamic recordings, incidence of de novo SUI, statistic analyzing by logistic regression and receiver operating characteristic curve （ROC）. Results （1） The study group had a much higher incidence of 30% （13/44） on de novo SUI than that of control group （4%, 2/49; P〈0.01）. （2） Vaginal delivery （0R=5.327, 95% CI： 1.120- 25.347）, constipation （0R=5.789, 95% CI： 1.492- 22.459）, preoperative OSUI （OR=13.695, 95% CI： 2.980-62.944）, anterior vaginal wall prolapse （0R=6.115, 95% CI： 1.231- 30.379） were identified as dependent risk factors for de novo SUI by logistic regression analysis. （3） For POP patients that complicated with OSUI, we chose a cutoff value of ＋ 1.5 cm for Aa point as the threshold to predicting incidence of de novo SUI according to ROC curve, area under the curve （AUC） was 0.889 （P〈 0.05）, the sensitivity reached 88.9% and specificity was 73.9%. According to ROC curve of Ba point, a cutoff value of ＋2.5 cm was chosen as the threshold to predicting incidence of de novo SUI post-operation, it had a sensitivity of 66.7% and specificity of 82.6%, AUC was 0.766 （P〈0.05）. Conclusions Pre-operative OSUI is a dependent risk factor of de novo SUI for advanced POP patients. Aa an
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2015年第6期415-419,共5页
Chinese Journal of Obstetrics and Gynecology
基金
国家自然科学基金（81270684）
湖北省卫生厅年度科研项目（NX2011-5）
