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目的:观察阴道封闭术对老年重度盆腔器官脱垂(POP)患者肠道梗阻及失禁等肠道困扰症状的疗效。方法:在2005年10月—2010年2月期间,采用盆底功能障碍症状问卷结直肠肛门困扰量表(CARDI-8)及生活质量问卷结直肠肛门影响问卷(CARIQ-7),对60例因POP-QⅢ～Ⅳ期重度POP而实施阴道封闭手术的患者,分别于术前及术后2个月、6个月及1年进行肠道困扰症状以及生活质量调查。问卷评分越低表明肠道困扰症状越轻,对患者生活质量影响越小。结果:术后2个月、6个月及1年时随访率分别为93%(56/60例)、88%(53/60例)和87%(52/60例)。11例术前有排便梗阻者于术后2个月时有6例症状消失,其余5例有不同程度改善。3例粪失禁者于术后2个月时有2例症状缓解,1例无改善。术后无新发肠道困扰症状。CARDI-8与CARIQ-7在术前及术后2个月、6个月及1年时的平均得分依次为(12.92±15.80)分、(5.19±7.18)分、(4.57±5.95)分、(4.48±5.93)分和(8.10±14.33)分、(4.51±8.92)分、(3.85±5.97)分、(3.78±5.93)分,术后评分较术前均有显著下降(P_(CARDI-8)=0.000 0,P_(CARIQ-7)<0.01)。结论:阴道封闭手术可以有效缓解老年POP患者排便梗阻症状并改善患者的生活质量;对粪失禁的疗效仍有待于进一步的临床研究。
Objective: To observe the effect of vaginal occlusion on intestinal obstruction and incontinence and other intestinal distress symptoms in elderly patients with severe pelvic organ prolapse (POP). Methods: From October 2005 to February 2010, the CARDI-8 questionnaire and the quality of life questionnaire for colorectal anorectal injury (CARIQ-7) were used in 60 cases Patients with vaginal closure undergoing POP-QIII-IV severe POPs were asked to investigate the symptoms of intestinal distress and quality of life at 2 months, 6 months and 1 year after surgery, respectively. The lower the questionnaire score indicates that the more symptoms of intestinal distress, the smaller the impact on the quality of life of patients. Results: Follow-up rates were 93% (56/60), 88% (53/60) and 87% (52/60) respectively at 2 months, 6 months and 1 year after operation. There were 6 cases of symptoms disappeared in 11 cases with preoperative defecation obstruction at 2 months after operation, and the remaining 5 cases improved to some extent. Three cases of fecal incontinence in 2 months after surgery, there are 2 cases of remission, 1 case without improvement. No new postoperative intestinal distress symptoms. The mean scores of CARDI-8 and CARIQ-7 were (12.92 ± 15.80), (5.19 ± 7.18) and (4.57 ± 5.95) points at preoperative, 2 months, 6 months and 1 year after surgery, (4.48 ± 5.93), (8.10 ± 14.33) points, (4.51 ± 8.92) points, (3.85 ± 5.97) points and (3.78 ± 5.93) points respectively. The score of postoperative score was significantly lower than that before operation (P_ (CARDI- 8) = 0.000 0, P_ (CARIQ-7) <0.01). Conclusion: Vaginal closure surgery can effectively relieve the symptoms of defecation obstruction and improve the quality of life of elderly patients with POP. The efficacy of incontinence remains to be further clinical studies.