摘要目的:基于疾病不确定感理论，对腹腔镜前列腺癌根治术（LRP）术后尿失禁患者盆底肌功能锻炼（PFME）依从性的影响因素进行分析，并构建结构方程模型。探讨疾病不确定感、社会支持、PFME自我效能和疾病应对机制对LRP术后尿失禁患者锻炼依从性的影响机制。方法:采用便利抽样法，选取2023年6月—2024年6月在同济大学附属第十人民医院接受LRP并进行PFME的300例术后尿失禁患者为研究对象。采用一般资料调查问卷、PFME依从性评分，疾病不确定感量表（MUIS-A）、盆底肌肉锻炼自我效能量表（BPMSES）、社会支持评定量表（SSRS）、医学应对方式问卷（MCMQ）对患者进行问卷调查。采用多重线性回归分析LRP术后尿失禁患者PFME依从性得分的影响因素；采用Pearson相关分析LRP术后尿失禁患者PFME依从性与疾病不确定感、自我效能、社会支持、医学应对方式的相关性；使用AMOS 26.0软件进行路径分析。结果:本研究发放问卷300份，回收有效问卷282份，问卷有效回收率为94.00%（282/300）。282例LRP术后尿失禁患者PFME依从性评分为（11.92±2.60）分，MUIS-A得分为（72.37±14.56）分，BPMSES得分为（166.98±17.10）分，SSRS得分为（50.69±6.73）分，MCMQ的面对、回避、屈服应对方式得分分别为（14.46±2.56）、（14.12±2.91）、（12.32±2.58）分。PFME依从性与MUIS-A得分、屈服应对方式均呈负相关（ r=-0.559、-0.606， P<0.01），与PFME自我效能、社会支持、面对应对方式均呈正相关（ r=0.494、0.539、0.118， P<0.05）。Bootstrap中介效应显示，疾病不确定不仅直接影响LRP术后尿失禁患者PFME依从性，还可通过3条间接路径影响患者PFME依从性：疾病不确定感→PFME自我效能→PFME依从性，效应值为-0.147（95% CI：-0.250~-0.085），占总效应的18.1%；疾病不确定感→屈服应对方式→PFME依从性，效应值为-0.184（95% CI：-0.270~-0.115），占总效应的22.7%；疾病不确定感→社会支持→PFME依从性，效应值为-0.173（95% CI：-0.300~-0.070），占总效应的21.4%；间接总效应占总效应的62.2%。 结论:LRP术后尿失禁患者PFME依从性偏低，疾病不确定感不仅直接影响患者PFME依从性，还可通过PFME自我效能、社会支持、屈服疾病应对方式对其产生间接作用。

abstractsObjective:To analyze the influencing factors of pelvic floor muscle exercise (PFME) compliance in patients with urinary incontinence after laparoscopic radical prostatectomy (LRP) based on the theory of disease uncertainty, and construct a structural equation model, so as to explore the impact mechanisms of disease uncertainty, social support, PFME self-efficacy, and disease coping styles on exercise compliance in patients with urinary incontinence after LRP.Methods:Convenience sampling was used to select 300 postoperative urinary incontinence patients who underwent LRP and PFME at Tenth People's Hospital of Tongji University between June 2023 and June 2024 as study subjects. Patients were assessed using the General Information Questionnaire, PFME Compliance Scale, Mishel Uncertainty in Illness Scale-Adult (MUIS-A), Broome Pelvic Muscle Self-Efficacy Scale (BPMSES), Social Support Rating Scale (SSRS), and Medical Coping Modes Questionnaire (MCMQ). Multiple linear regression analysis was employed to identify factors influencing PFME compliance in patients with urinary incontinence after LRP. Pearson correlation was used to analyze the correlation between PFME compliance and disease uncertainty, self-efficacy, social support, and medical coping styles in patients with urinary incontinence after LRP. AMOS 26.0 software was used for path analysis.Results:A total of 300 questionnaires were distributed, and 282 valid questionnaires were collected, with a valid response rate of 94.00% (282/300). Among 282 patients with urinary incontinence after LRP, the PFME Compliance Scale, MUIS-A, BPMSES, SSRS, and MCMQ scores for confrontation, avoidance, and resignation coping styles were (11.92±2.60), (72.37±14.56), (166.98±17.10), (50.69±6.73), (14.46±2.56), (14.12±2.91), and (12.32±2.58), respectively. PFME compliance showed negative correlations with MUIS-A scores and resignation coping style ( r=-0.559, -0.606; P<0.01), while exhibiting positive correlations with PFME self-efficacy, social support and confrontation coping style ( r=0.494, 0.539, 0.118; P<0.05). Bootstrap mediating analysis showed that disease uncertainty not only directly affected PFME compliance in patients with urinary incontinence after LRP, but also indirectly affected PFME compliance through three pathways: disease uncertainty→ PFME self-efficacy→ PFME compliance, with an effect value of -0.147 [95% CI (-0.250, -0.085) ], accounting for 18.1% of the total effect; disease uncertainty→ resignation coping style→ PFME compliance, with an effect value of -0.184 [95% CI (-0.270, -0.115) ], accounting for 22.7% of the total effect; disease uncertainty→ social support → PFME compliance, with an effect value of -0.173 [95% CI (-0.300, -0.070) ], accounting for 21.4% of the total effect. The indirect total effect constituted 62.2% of the total effect. Conclusions:Patients with urinary incontinence after LRP have low PFME compliance. Disease uncertainty not only directly affects PFME compliance, but also indirectly affects it through PFME self-efficacy, social support, and coping styles.