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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 鄒頡龍 | 肥胖是不是尿失禁手術的失敗或併發症的危險因子？ | 2011/6/28 下午 06:23:22 | 0 |
| 原 文 | 題 目 | Is Obesity a Risk Factor for Failure and Complications AfterSurgery for Incontinence and Prolapse in Women? |
| 作 者 | Rashel M. Haverkorn, B. Jill Williams, William S. Kubricht, III and Alex Gomelsky | |
| 出 處 | Journal of Urology | |
| 出版日期 | 2011 March | |
| 評 論 |
應力性尿失禁的嚴重程度與肥胖有關係嗎？之前已有多項醫學研究指出，身體質量指數（BMI）過高的患者，發生尿失禁的比例較高。站立時，腹部器官與脂肪組織的重力向下傳遞至骨盆底器官（包括膀胱）；腹腔內組織重量越重，產生的壓力越大，應力性尿失禁的症狀也可能越明顯。 Haverkorn醫師2011年發表於Journal of Urology的文章「肥胖是不是尿失禁手術的失敗或併發症的危險因子？」：「針對297位身體質量指數（BMI）大於30 kg/m2肥胖婦女接受尿失禁手術的結果，並與另外412名體重正常，接受尿失禁手術的婦女比較。所有患者或手術後追蹤12月。結果發現，手術成功率以及尿失禁治癒率在非肥胖組比較高。但是在整體症狀改善以及生活品質，不管是在肥胖組或非肥胖組在手術後都有進步。與非肥胖組比較，肥胖患者接受尿失禁手術發生併發症的機會並沒有比較高。看來，即使沒有減肥成功，還是可以接受尿失禁手術。 「成功減重」是所有體重過重者的願望，對心血管疾病、新陳代謝等慢性病之防治都有正面幫助，對於尿失禁，也有症狀改善的效果。如果您有尿失禁的困擾，同時體重過重，不妨先嘗試減重，也許有意想不到的收穫。 |
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| abstract |
Purpose: Obese women (body mass index 30 kg/m2 or greater) are considered to be at risk for postoperative complications and failure after stress incontinence surgery. We compare the outcomes in this population with nonobese women (body mass index less than 30 kg/m2) undergoing rectus fascia, porcine dermis and polypropylene sling procedures. Materials and Methods: We retrospectively identified 412 women with a body mass index less than 30 kg/m2 (94 autologous rectus fascia, 157 acellular porcine dermis, 161 transobturator polypropylene mid urethral sling) and 297 with a body mass index of 30 kg/m2 or greater (66 autologous rectus fascia, 114 acellular porcine dermis, 117 transobturator polypropylene mid urethral sling) who underwent sling procedures and other pelvic surgery. Evaluation included SEAPI assessment and quality of life questionnaires. Global cure equaled subjective SEAPI composite 0 and subjective satisfaction. Stress urinary incontinence cure equaled SEAPI (S) 0 and negative cough stress test. Chart review for perioperative data was conducted. Groups and outcomes were statistically compared. Results: All women had a minimum followup of 12 months. After controlling for body mass index preoperative demographics, SEAPI scores and quality of life indices were not statistically different within each sling group. Global cure and stress urinary incontinence cure rates were significantly higher for nonobese women in each sling group. Statistically significant improvement in SEAPI scores and quality of life indices was achieved for all groups, and there were no statistical differences within each sling group. Overall obese women had no increase in complications compared with nonobese women. The incidence of obstructive sequelae was statistically higher in nonobese women undergoing autologous rectus fascia and transobturator polypropylene mid urethral sling procedures. Conclusions: Although cure rates are lower, obese women have significant improvements in quality of life after surgery for stress urinary incontinence. Obesity does not appear to be a risk factor for additional complications during sling and prolapse surgery. |
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