CAJ | 학술논문

目的探讨重度盆腔器官脱垂（POP）患者选择手术治疗或子宫托治疗的影响因素。方法采用回顾性研究方法，收集2008年1月1日至2013年12月31日就诊于北京大学第三医院、有症状且要求治疗、无POP手术及子宫托治疗禁忌证的Ⅲ~Ⅳ度POP患者的临床资料，按患者意愿分为手术治疗（手术组）或子宫托治疗（子宫托组）两组共419例，比较两组患者的临床特点，包括就诊时年龄、体质指数（BMI）、发病年龄及患病年限、脱垂严重程度、有无POP手术史、内科合并症的差异。结果419例POP患者中手术组占67.5%（283/419），子宫托组占32.5%（136/419）。手术组患者BMI为（25.1±3.5）kg/m2，子宫托组为（23.8±2.6）kg/m2，两组比较，差异有统计学意义（P<0.01）。手术组患者的发病年龄为（62±12）岁，子宫托组为（57±11）岁，两组比较，差异有统计学意义（P<0.01）。手术组患者的患病年限为（5±8）年，子宫托组为（11±11）年，两组比较，差异有统计学意义（P<0.01）。中盆腔脱垂分度手术组高于子宫托组（分别为3.0±1.2、2.5±1.2），两组比较，差异有统计学意义（P<0.01）。手术组患者合并心脏疾病的比例（20.1%，57/283）少于子宫托组（30.9%，42/136），两组比较，差异有统计学意义（P=0.015）。以logistic回归分析以上有差异的因素，BMI（OR=1.141，95%CI为1.061~1.226，P<0.01）、患病年限（OR=0.932，95%CI为0.910~0.955，P<0.01）、中盆腔脱垂分度（OR=1.389，95%CI为1.171~1.647，P<0.01）是POP患者选择治疗方式的独立影响因素。结论在患者自愿选择的基础上，选择手术治疗者占67.5%，选择子宫托治疗者占32.5%。选择手术治疗的患者中，BMI高、合并心脏疾病者的比例小、中盆腔脱垂分度重。选择子宫托治疗的患者中，相对发病年龄小、患病年限长。
목적탐토중도분강기관탈수（POP）환자선택수술치료혹자궁탁치료적영향인소。방법채용회고성연구방법，수집2008년1월1일지2013년12월31일취진우북경대학제삼의원、유증상차요구치료、무POP수술급자궁탁치료금기증적Ⅲ~Ⅳ도POP환자적림상자료，안환자의원분위수술치료（수술조）혹자궁탁치료（자궁탁조）량조공419례，비교량조환자적림상특점，포괄취진시년령、체질지수（BMI）、발병년령급환병년한、탈수엄중정도、유무POP수술사、내과합병증적차이。결과419례POP환자중수술조점67.5%（283/419），자궁탁조점32.5%（136/419）。수술조환자BMI위（25.1±3.5）kg/m2，자궁탁조위（23.8±2.6）kg/m2，량조비교，차이유통계학의의（P<0.01）。수술조환자적발병년령위（62±12）세，자궁탁조위（57±11）세，량조비교，차이유통계학의의（P<0.01）。수술조환자적환병년한위（5±8）년，자궁탁조위（11±11）년，량조비교，차이유통계학의의（P<0.01）。중분강탈수분도수술조고우자궁탁조（분별위3.0±1.2、2.5±1.2），량조비교，차이유통계학의의（P<0.01）。수술조환자합병심장질병적비례（20.1%，57/283）소우자궁탁조（30.9%，42/136），량조비교，차이유통계학의의（P=0.015）。이logistic회귀분석이상유차이적인소，BMI（OR=1.141，95%CI위1.061~1.226，P<0.01）、환병년한（OR=0.932，95%CI위0.910~0.955，P<0.01）、중분강탈수분도（OR=1.389，95%CI위1.171~1.647，P<0.01）시POP환자선택치료방식적독립영향인소。결론재환자자원선택적기출상，선택수술치료자점67.5%，선택자궁탁치료자점32.5%。선택수술치료적환자중，BMI고、합병심장질병자적비례소、중분강탈수분도중。선택자궁탁치료적환자중，상대발병년령소、환병년한장。
Objective To investigate the factors influencing therapy decision of surgery or pessary in patients with severe pelvic organ prolapse (POP). Methods Totally 419 cases ofⅢtoⅣdegree POP patients were studied retrospectively. Patients were divided into surgery and pessary groups according to their own choice. Clinical characters were compared such as age, body mass index (BMI), age of onset and disease duration, POP stage, complications. Results 67.5%(283/419) patients were in the surgical group and 32.5%(136/419) patients in the pessary group. Patients in surgical group had higher BMI [(25.1 ± 3.5) versus (23.8±2.6) kg/m2], elder age of onset [(62±12) versus (57±11) years old], longer disease duration [(5± 8) versus (11±11) years] and higher POP staging of middle compartment and less cardiac disease [20.1%(57/283) versus 30.9% (42/136)] than those in pessary group, all had significant difference (P<0.05). Logistic regression analysis on the above factors showed a statistically significant difference between two groups, BMI, disease duration and POP staging of middle compartment were independent factors (OR=1.141, 0.932, 1.389;all P<0.01). Conclusions Patients with higher BMI, higher POP staging of middle compartment and less cardiac disease tended to choose surgery. Patients with younger age of onset and longer disease duration tended to choose pessary. Factors as age, POP staging of anterior and posterior compartment, history of POP surgery, complicated with hypertension and diabetes, showed no influence on treatment choice.