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目的 探讨硅胶子宫托治疗盆腔器官脱垂(POP)的效果及其影响因素.方法 对2005年10月-2011年10月于北京大学第三医院妇科门诊自愿佩戴硅胶子宫托治疗POP的132例患者的临床资料进行回顾性分析.采用盆底功能障碍问卷简表20 (PFDI-20)、盆底功能影响问卷简表7(PFIQ-7)和满意度评估调查评价疗效；比较使用6个月以上,6个月内放弃和试戴失败患者之间的临床特点的差异；调查试戴失败、满意度评分低和放弃使用的原因.结果 132例患者中,106例(106/132,80.3％)患者试戴成功,26例(26/132,19.7％)试戴失败.试戴成功患者随访率86.8％(92/106),中位随访时间为12.5个月.随访的92例患者中,78.3％ (72/92)持续使用,使用时间3～69个月；21.7％(20/92)的患者使用1～38个月后放弃,其中14例(14/20)发生在使用的前6个月.试戴成功患者中72例使用前PFDI-20、PFIQ-7中位评分分别为50.0分和47.6分,使用后分别为8.9分和0分,分别比较,差异均有统计学意义(P＜0.05).70例患者完成满意度评估调查,87.1％ (61/70)对治疗效果满意.比较使用6个月以上,6个月内放弃和试戴失败患者间的年龄、体质指数、盆腔手术史、子宫托类型、脱垂部位和分期,差异均无统计学意义(P＞0.05).子宫托取放困难或自觉麻烦是患者试戴失败、满意度评分低和放弃使用的主要原因.结论 硅胶子宫托治疗POP的成功率较高,可显著缓解患者症状,提高其生命质量.取放困难或患者自觉麻烦是影响子宫托使用的主要因素,在使用最初6个月内应加强随访和指导.

Objective To evaluate the therapeutic effect and influence factors of silicone pessary in treatment of pelvic organ prolapse ( POP).Methods From October 2005 to October 2010,132 with symptomatic POP managed by pessary were enrolled in this retrospective study.Validated prolapse quality of life questionnaire (pelvic floor distress inventory short form 20,PFDI-20),pelvic floor impact questionnaire short form 7 (PFIQ-7) and the patients' satisfaction degree were used to evaluate the therapeutic effect.Clinical characteristic of the patients with successful using for more than 6 months ( successful fitting group),giving up within 6 months (giving up group),unsuccessful fitting (unsuccessful fitting group)were compared.Factors influencing satisfaction degree and causing discontinuation were investigated.Results One hundred and six among 132 ( 106/132,80.3％ ) patients were in successful fitting group,26 (26/132,19.7％ ) patients were in the unsuccessful fitting group.In the successful fitting group,86.8％ (92/106) patients were followed up,the median follow-up time was 12.5 months.And 78.3％ ( 72/92 ) patients continued to use pessary with the wearing time ranged 3 -69 months; 21.7％ (20/92) patients discontinued with the wearing time ranged 1 -38 month,14 patients (14/20) gave up in the initial 6 months.The median scores of PFDI-20 and PFIQ-7 questionnaires before pessary use were 50.0 and 47.6,which decreased to 8.9 and 0.0 after pessary use (P＜0.05).And 87.1％ (61/70) patients were satisfied.There was no significantly difference among 3 groups on clinical characteristics,such as age,body mass index ( BMI ),pelvic surgery and so on (P ＞ 0.05 ).The main factor influencing satisfaction degree and causing discontinuation was difficulties in placing and removing.Conclusions Silicone pessary is effective for patients with POP.It could relieve discomfort symptoms and improve quality of life.The main factorinfluencing pessary use is difficulties in placing and removing.Thus,More suggestions are needed for patients in the initial 6 months.