目的:探讨经腹子宫全切术后盆底功能障碍的关联因素,制定应对策略提供参考.方法:回顾性收集2020年1月—2022年11月本院全子宫切除术患者84例临床资料,根据术后1年随访是否并发盆底功能障碍性疾病(PDF)分为PDF组(n=32)、无PDF组(n=52).收集两组相关临床资料,单因素分析探讨经腹子宫全切术后PDF的可能影响因素,多因素logistic回归分析明确独立影响因素.结果:PDF组32例中包括6例单纯盆腔器官脱垂、4例单纯压力性尿失禁、3例单纯性功能障碍、1例单纯大便失禁,同时伴≥2种18例.两组年龄、体质指数、绝经、孕次、产次、术中出血量、术后留置尿管时间、过早负重等有差异(P＜0.05).多因素分析显示,绝经、术中出血量并非经腹子宫全切术后 PDF 的独立影响因素(P＞0.05),年龄大(OR=1.270、95％CI 1.036～1.558)、体质指数高(OR=2.672、95％CI 1.376～5.190)、孕次多(OR=8.947、95％CI 2.566～31.193)、产次多(OR=12.302、95％CI 3.039～49.802)、术后留置尿管时间长(OR=1.561、95％CI 1.120～2.177)、过早负重(OR=3.713、95％CI 1.628～8.470)均为经腹子宫全切术后发生PDF的独立危险因素(均P＜0.05).结论:经腹子宫全切术后PDF的发生与患者年龄、体质指数、孕次、产次、术后留置尿管时间、过早负重有关,提示临床应依据上述因素识别高风险人群,增强围术期管理.
Analysis of the influence factors of pelvic floor dysfunction after transabdominal total hysterectomy
Objective:To explore the related factors of pelvic floor dysfunction after transabdominal total hysterectomy,and to provide reference for the countermeasures.Methods:The clinical data of 84 patients who had undergone total hysterectomy in hospital from January 2020 to November 2022 were collected retrospectively.These patients were di-vided into group A(32 case with pelvic floor dysfunction(PDF))and group B(52 case without PDF)according to whether the patients with PDF complicated or not in 1 year after operation.The relevant clinical data of the patients in the two groups were collected.Univariate analysis was used to explore the possible influencing factors of the PDF oc-currence of the patients after total hysterectomy,and then the independent influencing factors of the PDF occurrence of the patients were identified by multivariate logistic regression analysis.Results:In group A,there were 6 cases with simple pelvic organ prolapse,4 cases with simple stress urinary incontinence,3 cases with simple sexual dysfunction and 1 case with simple fecal incontinence,and there were 18 cases with more than two kinds of PDF.There were sig-nificant differences in the age,the body mass index,the menopause situation,the gravidity,the parity,the intraopera-tive blood loss,the time of postoperative indwelling catheter,and the early weight bearing situation of the patients be-tween the two groups(P＜0.05).Multivariate analysis showed that the menopause and the intraoperative blood loss of the patients were not the independent influencing factors of their PDF occurrence after transabdominal total hysterecto-my(P＞0.05).The advanced age(OR=1.270,95％CI 1.036-1.558),the higher body mass index(OR=2.672,95％CI 1.376-5.190),the more gravidity(OR=8.947,95％CI 2.566-31.193),the more parity(OR=12.302,95％CI 3.039-49.802),the longer time of postoperative indwelling catheter(OR=1.561,95％CI 1.120-2.177)and the early weight bearing(OR=3.713,95％CI 1.628-8.470)of the patients with transabdominal total hysterectomy were the in-dependent risk factors of their PDF occurrence(all P＜0.05).Conclusion:The PDF occurrence of the patients after transabdominal total hysterectomy is related to their age,body mass index,gravidity,parity,time of postoperative in-dwelling catheter and early weight-bearing.It is suggested that the high-risk patients with PDF should be identified based on the above factors,so as to enhance the perioperative management of the patients.
Transabdominal total hysterectomyPelvic floor dysfunctionInfluence factors
万方数据
维普
