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許竣凱 子宮保存和降低陰道脫垂手術術後尿滯留相關 2020/12/31 下午 04:20:51 0
原 文 題  目 Uterus Preservation in Case of Vaginal Prolapse Surgery Acts as a Protector against Postoperative Urinary Retention
作  者 Christine Bekos, Raffaela Morgenbesser, Heinz Kölbl, Heinrich Husslein, Wolfgang Umek, Klaus Bodner, and Barbara Bodner-Adler
出  處 Journal of Clinical Medicine
出版日期 2020/11/23
評 論 目前仍然沒有定論,是否在進行骨盆腔器官脫垂重建時順便切除子宮,如果有臺灣自己前瞻性研究也許能更好的回答這個問題。切除子宮時為了避免流血,勢必會破壞較多附屬組織,這些附屬組織有少量支撐或供應營養及神經穿過的功能,雖然跟手術縫合或是植入網膜相比,支撐力遠遠不足,但仍可能跟殘尿有關。反過來說,切除子宮可能可以避免未來發生內膜異常或是癌症的風險,或是提供較好的手術視野。患者在手術前可與醫師討論。
abstract 這項回顧性研究收錄了2017年1月至2019年7月期間接受骨盆腔器官脫垂手術的女性。評估術後殘餘尿量,尿滯留定義為殘尿量大於150 mL。術後第一天殘餘尿量增加了31.8%(56/176)。身體質量指數(BMI)較低者也有顯著較低的殘尿量(p = 0.040)。此外,在多元邏輯回歸分析中,低BMI(p = 0.009)和子宮切除術(p = 0.032)是與殘尿量增加顯著相關的因素。

Background: The aim of this study was to identify clinical risk factors for increased post-void residual (PVR) volumes in patients undergoing vaginal prolapse surgery and to find out whether uterus preservation or prolapse hysterectomy influences the incidence of postoperative urinary retention.

Methods: This retrospective study included women who presented with pelvic organ prolapse (POP) and planned prolapse surgery between January 2017 and July 2019. PVR was assessed postoperatively and increased amounts were defined as incomplete voiding with residual urine volume greater than 150 mL.

Results: Increased PVR at the first postoperative day occurred in 31.8% (56/176). Body mass index (BMI) was significantly lower in patients with increased PVR after pelvic floor surgery compared to patients with normal PVR amounts (p = 0.040). Furthermore, during multiple logistic regression analysis, low BMI (p = 0.009) as well as prolapse hysterectomy (p = 0.032) turned out to be the strongest risk factors associated with increased PVR volume.

Conclusion: This is the first study identifying prolapse hysterectomy as an independent risk factor for increased PVR after surgical prolapse repair. Our results might be helpful in counseling patients prior to surgery and underline the option of uterus preservation during prolapse surgery in selected cases.
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