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目的探讨尿动力学检查(UDS)在盆腔器官脱垂(POP)患者中的应用价值。方法回顾性分析2012年1月至2013年12月在北京大学人民医院妇科接受盆底重建手术的348例POP患者的临床资料。根据是否同时合并压力性尿失禁(SUI)将患者分为POP+SUI组和单纯POP组。结果 1 348例POP患者中,142例(40.8%)合并SUI,其中111例患者术前接受UDS检查,但仅有52.3%(58/111)的患者表现为尿动力学SUI(UDS-SUI)。196例单纯POP组患者中,158例行术前UDS检查,8例(5.1%)表现为UDS-SUI,提示隐匿性SUI。2 POP+SUI组中,73例同时行抗尿失禁手术,69例未同时行抗尿失禁手术,术后SUI持续或加重者分别为4.1%(3/73)和29.0%(20/69)。单纯POP组中193未行预防性抗尿失禁手术,术后53例出现不同程度SUI,术后新发SUI(De novo SUI)27.5%(53/193)。单纯POP组中,3例UDS-SUI患者接受抗利尿手术,术后无SUI;5例未行抗尿失禁手术者术后均出现SUI症状。结论对于POP合并单纯SUI患者,无论UDS是否见腹压漏尿,均推荐盆底重建手术同时行抗尿失禁手术,因此术前可不做UDS检查。术前无SUI症状者UDS有助于发现隐匿性SUI,指导手术方式选择,推荐行UDS检查。POP合并复杂下尿路症状者应接受UDS检查。
Objective To investigate the value of urodynamic examination (UDS) in patients with pelvic organ prolapse (POP). Methods The clinical data of 348 patients with POP treated by pelvic floor reconstruction at Peking University People’s Hospital from January 2012 to December 2013 were retrospectively analyzed. Patients were divided into POP + SUI group and pure POP group according to whether they were combined with stress urinary incontinence (SUI). Results Of the 1 348 cases of POP, 142 (40.8%) were complicated with SUI. Of 111 cases, UDS was performed preoperatively, but only 52.3% (58/111) showed urodynamic SUI (UDS-SUI) . Of 196 patients with POP alone, 158 had preoperative UDS and 8 (5.1%) presented with UDS-SUI, suggesting an occult SUI. In the POP + SUI group, 73 patients underwent simultaneous urinary incontinence surgery and 69 patients did not undergo simultaneous urinary incontinence surgery. The persistent or exacerbated postoperative SUI were 4.1% (3/73) and 29.0% (20/69), respectively . In the simple POP group, there was no pre-operative anti-incontinence surgery in 193 cases. There were 53 SUI patients and 27.5% (53/193) new SUI patients after operation. In pure POP group, 3 cases of UDS-SUI patients underwent anti-diuretic surgery without SUI after surgery. All 5 cases had SUI symptoms after operation without urinary incontinence. Conclusions For patients with POP combined with simple SUI, pelvic floor reconstruction surgery and urinary incontinence surgery are both recommended regardless of whether UDS see abdominal leakage, so do not do UDS before surgery. Preoperative SUI symptoms of UDS help to find occult SUI, guide surgical options, recommended line UDS examination. POP complicated with lower urinary tract symptoms should receive UDS examination.