Clinical study of pelvic organ prolapse about anorectal dynamics

doi:10.3877/cma.j.issn.1673-5250.2016.05.007

Objective

To study the symptoms, and anorectal dynamics in women with pelvic organ prolapse (POP), so as to comprehensively assess anorectal dysfunction in POP.

Methods

A total of 59 cases of postmenopausal patients with POP in Shenzhen people′s Hospital from November 2011 to March 2013 were included in the POP group, at the same time 46 cases of postmenopausal patients without POP in the same hospital were included as control group. They were evaluated with a validated questionnaire (Colorectal-anal Distress Inventory 8), and anorectal manometry to assess the anorectal dysfunction of POP. The study followed the ethical standards of the human trials of the Shenzhen People′s Hospital, approved by the committee, and clinical research informed consent was signed by each patient.

Results

①There were no statistically significant differences between two groups among age, gravidity, parity, the duration of menopause, and body mass index (P>0.05). ②There were no statistically significant differences between the POP patients of anterior vaginal wall prolapse Ⅱ degree+ Ⅲ degree and Ⅳ degree, uterus prolapse Ⅰ-Ⅲ degree and Ⅳ degree, posterior vaginal wall prolapsed Ⅰ degree+ Ⅱ degree and Ⅲdegree+ Ⅳ degree among resting and squeezing pressure and the rectum capacity of minimal sensation, normal defecation and strong defecation (P>0.05). ③There were bigger rectum capacity of normal defecation and stronger defecation in POP patients with difficult defecation than those of patients without difficult defecation, and the differences were statistically significant (t=4.93, 4.67; both P=0.000). But there were no statistically significant differences between the two groups among resting and squeezing pressure and the rectum capacity of minimal sensation (P>0.05). ④A total of 115 sets of Colorectal-anal Distress Inventory 8 questionnaires were handed out to POP group and control group, and 115 sets of valid questionnaires were collected, the feedback rate of the questionnaires were 100%. The POP group got more scores in questionnaires than control group, and the difference was statistically significant (t=4.81, P=0.000). ⑤There were lower resting and squeezing pressure in POP patients than those in control group, and the differences were statistically significant (t=3.15, 3.43; P=0.002, 0.001). There were bigger rectum capacity of minimal sensation, normal defecation and stronger defecation in POP patients than those in control group, and the differences wre statistically significant (t=3.42, 3.95, 3.83; P=0.001, 0.000, 0.000).

Conclusions

Patients with POP is often associated with a variety of symptoms, including difficult defecation, fecal incontinence endless defecate, which lead to the lower quality of life. The anorectal contraction and sensory function are decreased in patients with POP, but they are not associated with the degree of posterior vaginal wall prolapsed, but with the POP with difficulty defecating or not.

Key words: Pelvic organ prolapse, Clinical symptoms, Anorectal manometry, Women, postmenopause

表1 盆腔器官脱垂定量分度法

POP-Q分度	具体标准
POP-Q分度	解剖描述	定位描述
0度	盆腔器官无脱垂	Aa、Ap、Ba、Bp点均在处女膜缘－3 cm处，C点或D点位置在其－tvl～－tvl＋2 cm处
Ⅰ度	范围大于0级，脱垂的最远端在处女膜缘内侧，距处女膜缘>1 cm	脱垂的最远端定位于处女膜缘<－1 cm
Ⅱ度	脱垂的最远端在处女膜缘内侧或外侧，距处女膜缘<1 cm	脱垂的最远端定位于－1～＋1 cm
Ⅲ度	脱垂的最远端在处女膜缘外侧，距处女膜缘>1 cm，但<tvl－2 cm	脱垂的最远端定位于处女膜缘＋1～tvl－2 cm
Ⅳ度	全部脱出，脱垂的最远端超过处女膜缘>tvl－2 cm	脱垂的最远端定位于处女膜缘>tvl－2 cm

表1 盆腔器官脱垂定量分度法

POP-Q分度	具体标准
POP-Q分度	解剖描述	定位描述
0度	盆腔器官无脱垂	Aa、Ap、Ba、Bp点均在处女膜缘－3 cm处，C点或D点位置在其－tvl～－tvl＋2 cm处
Ⅰ度	范围大于0级，脱垂的最远端在处女膜缘内侧，距处女膜缘>1 cm	脱垂的最远端定位于处女膜缘<－1 cm
Ⅱ度	脱垂的最远端在处女膜缘内侧或外侧，距处女膜缘<1 cm	脱垂的最远端定位于－1～＋1 cm
Ⅲ度	脱垂的最远端在处女膜缘外侧，距处女膜缘>1 cm，但<tvl－2 cm	脱垂的最远端定位于处女膜缘＋1～tvl－2 cm
Ⅳ度	全部脱出，脱垂的最远端超过处女膜缘>tvl－2 cm	脱垂的最远端定位于处女膜缘>tvl－2 cm

表2 两组患者一般资料比较(±s)

组别	例数	年龄(岁)	绝经时间(年)	孕次(次)	产次(次)	人体质量指数(kg/m²)
POP组	59	62.4±10.4	13.4±10.4	4.3±1.6	3.2±1.6	23.7±2.4
对照组	46	60.7±5.4	12.3±5.3	4.1±1.3	2.8±1.2	24.0±4.0
t值	?	0.99	0.68	0.62	1.11	0.46
P值	?	0.324	0.498	0.537	0.270	0.646

表2 两组患者一般资料比较(±s)

组别	例数	年龄(岁)	绝经时间(年)	孕次(次)	产次(次)	人体质量指数(kg/m²)
POP组	59	62.4±10.4	13.4±10.4	4.3±1.6	3.2±1.6	23.7±2.4
对照组	46	60.7±5.4	12.3±5.3	4.1±1.3	2.8±1.2	24.0±4.0
t值	?	0.99	0.68	0.62	1.11	0.46
P值	?	0.324	0.498	0.537	0.270	0.646

表3 POP组(n＝59)患者的盆腔器官脱垂分类及程度[例数(%)]

POP程度(度)	阴道前壁脱垂率	子宫脱垂率	阴道后壁脱垂率
Ⅰ	0(0)	1(1.7)	15(25.4)
Ⅱ	3(5.1)	8(13.5)	12(20.3)
Ⅲ	30(50.8)	27(45.8)	27(45.8)
Ⅳ	26(44.1)	23(39.0)	5(8.5)
合计	59(100.0)	59(100.0)	59(100.0)

表3 POP组(n＝59)患者的盆腔器官脱垂分类及程度[例数(%)]

POP程度(度)	阴道前壁脱垂率	子宫脱垂率	阴道后壁脱垂率
Ⅰ	0(0)	1(1.7)	15(25.4)
Ⅱ	3(5.1)	8(13.5)	12(20.3)
Ⅲ	30(50.8)	27(45.8)	27(45.8)
Ⅳ	26(44.1)	23(39.0)	5(8.5)
合计	59(100.0)	59(100.0)	59(100.0)

表4 POP组(n＝59)不同部位不同程度脱垂患者的肛管、直肠压力参数比较(±s)

部位	脱垂程度	例数	肛管静息压(mmHg)	肛管最大收缩压(mmHg)	直肠最小感觉容量(mL)	直肠初始排便容量(mL)	直肠最大阈值容量(mL)
阴道前壁脱垂	Ⅱ度＋Ⅲ度	33	42.5±14.6	107.7±28.9	38.3±26.8	73.3±34.8	142.1±51.8
?	Ⅳ度	26	50.4±23.9	117.1±23.3	29.8±11.3	85.1±31.6	128.8±35.2
t值	?	?	1.48	1.35	1.65	1.35	1.12
P值	?	?	0.144	0.182	0.104	0.182	0.267
子宫脱垂	Ⅰ～Ⅲ度	36	45.6±22.3	105.6±31.3	38.6±25.4	79.3±33.2	141.8±46.3
子宫脱垂	Ⅳ度	23	43.4±10.6	116.6±22.9	30.5±12.7	75.0±36.2	126.0±44.6
t值	?	?	0.51	1.45	1.62	0.47	1.30
P值	?	?	0.612	0.153	0.111	0.640	0.199
阴道后壁脱垂	Ⅰ度＋Ⅱ度	27	40.9±14.3	105.1±32.3	40.3±30.4	76.7±35.1	132.8±55.2
阴道后壁脱垂	Ⅲ度＋Ⅳ度	32	49.9±22.0	115.4±22.9	31.1±11.0	79.1±33.3	140.1±38.0
t值	?	?	1.49	1.43	1.49	0.27	0.58
P值	?	?	0.142	0.158	0.142	0.788	0.564

表4 POP组(n＝59)不同部位不同程度脱垂患者的肛管、直肠压力参数比较(±s)

部位	脱垂程度	例数	肛管静息压(mmHg)	肛管最大收缩压(mmHg)	直肠最小感觉容量(mL)	直肠初始排便容量(mL)	直肠最大阈值容量(mL)
阴道前壁脱垂	Ⅱ度＋Ⅲ度	33	42.5±14.6	107.7±28.9	38.3±26.8	73.3±34.8	142.1±51.8
?	Ⅳ度	26	50.4±23.9	117.1±23.3	29.8±11.3	85.1±31.6	128.8±35.2
t值	?	?	1.48	1.35	1.65	1.35	1.12
P值	?	?	0.144	0.182	0.104	0.182	0.267
子宫脱垂	Ⅰ～Ⅲ度	36	45.6±22.3	105.6±31.3	38.6±25.4	79.3±33.2	141.8±46.3
子宫脱垂	Ⅳ度	23	43.4±10.6	116.6±22.9	30.5±12.7	75.0±36.2	126.0±44.6
t值	?	?	0.51	1.45	1.62	0.47	1.30
P值	?	?	0.612	0.153	0.111	0.640	0.199
阴道后壁脱垂	Ⅰ度＋Ⅱ度	27	40.9±14.3	105.1±32.3	40.3±30.4	76.7±35.1	132.8±55.2
阴道后壁脱垂	Ⅲ度＋Ⅳ度	32	49.9±22.0	115.4±22.9	31.1±11.0	79.1±33.3	140.1±38.0
t值	?	?	1.49	1.43	1.49	0.27	0.58
P值	?	?	0.142	0.158	0.142	0.788	0.564

表5 POP组(n＝59)伴或不伴排便困难患者的肛管、直肠压力参数比较(±s)

POP组患者	例数	肛管静息压(mmHg)	肛管最大收缩压(mmHg)	直肠最小感觉容量(mL)	直肠初始排便容量(mL)	直肠最大阈值容量(mL)
有排便困难	27	47.1±24.9	112.4±29.5	41.3±30.0	100.6±37.7	166.3±49.3
无排便困难	32	43.5±15.6	108.2±29.8	42.5±12.0	62.9±19.6	117.1±30.8
t值	?	0.67	0.55	0.22	4.93	4.67
P值	?	0.506	0.584	0.827	0.000	0.000

表5 POP组(n＝59)伴或不伴排便困难患者的肛管、直肠压力参数比较(±s)

POP组患者	例数	肛管静息压(mmHg)	肛管最大收缩压(mmHg)	直肠最小感觉容量(mL)	直肠初始排便容量(mL)	直肠最大阈值容量(mL)
有排便困难	27	47.1±24.9	112.4±29.5	41.3±30.0	100.6±37.7	166.3±49.3
无排便困难	32	43.5±15.6	108.2±29.8	42.5±12.0	62.9±19.6	117.1±30.8
t值	?	0.67	0.55	0.22	4.93	4.67
P值	?	0.506	0.584	0.827	0.000	0.000

表6 两组患者肛管、直肠压力参数测定结果比较(±s)

组别	例数	肛管静息压(mmHg)	肛管最大收缩压(mmHg)	直肠最小感觉容量(mL)	直肠初始排便容量(mL)	直肠最大阈值容量(mL)
POP组	59	45.9±19.3	109.7±28.9	36.1±22.3	78.4±33.2	136.8±45.2
对照组	46	60.5±28.0	134.4±44.4	23.3±13.4	55.2±25.1	108.8±22.8
t值	?	3.15	3.43	3.42	3.95	3.83
P值	?	0.002	0.001	0.001	0.000	0.000

表6 两组患者肛管、直肠压力参数测定结果比较(±s)

组别	例数	肛管静息压(mmHg)	肛管最大收缩压(mmHg)	直肠最小感觉容量(mL)	直肠初始排便容量(mL)	直肠最大阈值容量(mL)
POP组	59	45.9±19.3	109.7±28.9	36.1±22.3	78.4±33.2	136.8±45.2
对照组	46	60.5±28.0	134.4±44.4	23.3±13.4	55.2±25.1	108.8±22.8
t值	?	3.15	3.43	3.42	3.95	3.83
P值	?	0.002	0.001	0.001	0.000	0.000

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