老年子宫脱垂患者腹腔镜下阴道/子宫骶骨固定术前后生活质量情况及其影响因素

Quality of life before and after laparoscopic colposacropexy and its influencing factors in elderly patients with uterine prolapse

【摘要】目的 探讨老年子宫脱垂患者腹腔镜下阴道/子宫骶骨固定术前后生活质量变化,并评估生活质量的影响因素。方法 使用简单随机抽样法对2021年1月至2023年6月上海交通大学附属第九人民医院收治的136例行腹腔镜下阴道/子宫骶骨固定术治疗的老年子宫脱垂患者展开问卷调查。术前、术后3个月及术后6个月,使用盆底功能障碍性疾病症状问卷简表(PFDI-20)评估患者症状变化,盆底疾病生活质量问卷-短表7(PFIQ-7)评估患者生活质量变化,盆腔器宫脱垂定量(POP-Q)评估子宫脱垂程度变化。完成3次调查且问卷有效的为128例。以术后6个月PFIQ-7评分≤19.04分为生活质量良好的标准,将患者分为生活质量良好组(66例)与生活质量不良组(62例)。采用SPSS 24.0统计软件进行数据分析。根据数据类型分别采用单因素方差分析或χ²检验进行组间比较。使用多因素logistic回归模型分析老年子宫脱垂患者术后6个月生活质量不良的影响因素。结果 128例老年子宫脱垂患者术后6个月内均未复发,患者术后PFDI-20及PFIQ-7评分均显著低于术前,且术后6个月的评分低于术后3个月；患者术后Ba、C、Bp点的POP-Q测量值均较术前改善,差异有统计学意义(P＜0.05)。生活质量良好组与生活质量不良组体质量指数(BMI)、产次、慢性便秘率、子宫脱垂程度及术后并发症发生率比较,差异有统计学意义(P＜0.05)。logistic回归分析显示,BMI≥27.0kg/m²(OR=4.284,95%CI 2.706～6.784；P＜0.05)、产次≥3次(OR=3.397,95%CI 1.786～6.483；P＜0.05)、慢性便秘(OR=2.550,95%CI 1.159～5.610；P＜0.05)、子宫脱垂Ⅳ度(OR=3.307,95%CI 1.772～6.171；P＜0.05)及术后并发症(OR=2.492,95%CI 1.132～5.484；P＜0.05)均为老年子宫脱垂患者术后6个月生活质量不良的危险因素。结论 老年子宫脱垂患者腹腔镜下阴道/子宫骶骨固定术后生活质量随术后时间的延长而升高,但肥胖、多产、慢性便秘、重度子宫脱垂及术后并发症是导致患者术后生活质量不良的重要因素,临床可针对上述因素给予相应的防控措施。

基金项目:国家自然科学基金(81800331)；上海市卫生健康委员会卫生行业临床研究专项(20224Y0163)；上海交通大学附属第九人民医院院级研究基金项目(JYHL2022QN11)

【Abstract】Objective To explore the changes in quality of life before and after laparoscopic colposacropexy in elderly patients with uterine prolapse and to evaluate the influencing factors of quality of life. Methods Using a simple random sampling method, a questionnaire survey was conducted on 136 elderly patients with uterine prolapse, who underwent laparoscopic colposacropexy in Shanghai Ninth People′s Hospital Affiliated to Shanghai Jiaotong University from January 2021 to June 2023. Before surgery, and at 3 months and 6 months after surgery, pelvic floor distress inventory-short form 20 (PFDI-20) was used to evaluate the symptom changes of the patients, and pelvic floor impact questionnaire-short form 7 (PFIQ-7) was used to evaluate the changes in their quality of life. Pelvic organ prolapse quantification (POP-Q) was performed to evaluate the degree of uterine prolapse. Totally, 128 patients completed three surveys and the questionnaires were valid. Based on the PFIQ-7 score≤19.04 points at 6 months after surgery as the standard of good quality of life, they were divided into a good quality of life group (n=66) and a poor quality of life group (n=62). SPSS 24.0 was used for data analysis. According to the data type, one-way analysis of variance or Chi-square test was performed for between-group comparison. Multivariate logistic regression model was employed to analyze the influencing factors of poor quality of life in the elderly patients with uterine prolapse at 6 months after surgery. ResultsNo recurrence was found in the 128 elderly patients with uterine prolapse within 6 months after surgery. The PFDI-20 score and PFIQ-7 scores after surgery were significantly lower than those before surgery, and the scores at 6 months after surgery were lower than those at 3 months after surgery. The postoperative POP-Q measurements at Ba, C and Bp points were improved compared with those before surgery, and the differences were statistically significant (P<0.05). The differences in body mass index (BMI), parity, chronic constipation rate, degree of uterine prolapse, and incidence rates of postoperative complications were statistically significant between good quality of life group and poor quality of life group (P<0.05). Logistic regression analysis showed that BMI ≥ 27.0 kg/m² (OR=4.284,95%CI 2.706-6.784; P<0.05), parity≥ 3 times (OR=3.397,95%CI 1.786-6.483; P<0.05), chronic constipation (OR=2.550,95%CI 1.159-5.610; P<0.05), uterine prolapse Ⅳ degree (OR=3.307,95%CI 1.772-6.171; P<0.05), and postoperative complications (OR=2.492,95%CI 1.132-5.484; P<0.05) were risk factors of poor quality of life in the elderly patients with uterine prolapse at 6 months after surgery. Conclusion The quality of life after laparoscopic colposacropexy in the elderly patients with uterine prolapse increases with the extention of postoperative time, but obesity, multiparity, chronic constipation, severe uterine prolapse, and postoperative complications are important factors leading to poor postoperative quality of life. Clinically, it is necessary to take corresponding prevention and control measures for the above factors.

This work was supported by the National Natural Science Foundation of China (81800331), Clinical Research Project in Health Industry of Shanghai Health Commission (20224Y0163) and Research Fund of Shanghai Ninth People′ s Hospital Affiliated to Shanghai Jiaotong University (JYHL2022QN11) .