产后盆底康复治疗远期疗效的随访分析(1)
【摘要】目的了解產后盆底康复治疗对产妇3年后盆底功能的远期疗效。方法收集产后2个月复诊并填写压力性尿失禁(SUI)问卷和进行盆腔器官脱垂(POP)定量分度法(POP-Q)及盆底肌纤维肌力评分的产妇，根据其本人意愿分为治疗组和对照组。治疗组患者进行盆底康复综合治疗，并在治疗结束后指导长期坚持进行盆底肌肉锻炼；对照组则不给予任何治疗及指导。3年后对所有患者进行电话随访并进行SUI评估，鼓励所有患者返院复诊，对最终复诊者进行POP-Q及盆底肌纤维肌力评分，比较2组SUI、POP发生率及盆底肌纤维肌力改善情况。结果研究共纳入444例产妇，其中治疗组101例、对照组343例(有SUI电话随访资料)，3年后治疗组复诊45例、对照组复诊49例(有POP-Q及盆底肌纤维肌力评价资料)。2组复诊和未复诊的患者在产后2个月的POP发生率及盆底肌纤维肌力比较差异均无统计学意义(P均>0.05)。治疗前，2组的SUI、POP发生率及盆底Ⅰ、Ⅱ类肌纤维肌力分布比较差异均无统计学意义(P均>0.05)。治疗后3年，2组SUI发生率较治疗前下降(P均<0.01)，POP发生率均无变化(P均>0.05)。盆底Ⅰ、Ⅱ类肌纤维肌力均比治疗前改善(P均<0.01)。治疗后3年，治疗组、对照组患者的SUI、POP减少率组间比较差异均无统计学意义(P均>0.05)。治疗组盆底Ⅰ、Ⅱ类肌纤维肌力改善情况均优于对照组(P均<0.01)。结论产后盆底康复治疗对盆底肌纤维肌力的远期改善有效，未发现产后盆底康复治疗对减少SUI及POP发生率的远期疗效。
【关键词】盆底康复治疗；压力性尿失禁；盆腔器官脱垂；盆底肌纤维肌力
【Abstract】ObjectiveTo evaluate the long-term efficacy of postpartum pelvic floor rehabilitation treatment on the pelvic floor function at 3 years after delivery. MethodsDuring the return visit at 2 months after delivery， the stress urinary incontinence (SUI) questionnaire was distributed and the pelvic floor muscular strength score was assessed by pelvic organ prolapse quantification (POP-Q). All women were divided into the treatment and control groups according to their willingness. Patients in the treatment group received comprehensive pelvic floor rehabilitation treatment and were instructed to take pelvic floor muscle exercises for a long time after the rehabilitation therapy. No guidance or instructions were delivered in the control group. After 3 years， all patients were followed up by telephone and the SUI was assessed. All participants were encouraged to pay a return-visit. POP-Q and pelvic floor muscle strength scores were evaluated. The SUI score， the incidence of POP and the improvement of pelvic floor muscle strength were statistically compared between two groups. ResultsA total of 444 women were enrolled including 101 in the treatment group and 343 in the control group (SUI data by telephone follow-up). In the treatment group， 45 cases and 49 in the control group (POP-Q and pelvic floor muscle strength evaluation data) attended the 3-year follow-up. At 2 months after delivery， the incidence of POP and pelvic floor muscle strength did not significantly differ between two groups(both P>0.05). Prior to corresponding treatment， the incidence of SUI and POP and the distribution of type Ⅰ and Ⅱ pelvic floor muscle strength did not significantly differ between two groups (all P>0.05). At 3 years after treatment， the incidence of SUI were significantly decreased and the type Ⅰ and Ⅱ pelvic floor muscle strength were significantly enhanced in both groups (all P<0.01). There were no significantly change of the incidence of POP in both groups (all P>0.05). The incidence decrease of SUI and POP did not significantly differ between two groups (both P>0.05). In the treatment group， type Ⅰ and Ⅱ pelvic floor muscle strength was significantly improved compared with that in the control group (both P<0.01). ConclusionPostpartum pelvic floor rehabilitation treatment yields long-term efficacy in enhancing the pelvic floor muscle strength， whereas it fails to reduce the incidence of SUI and POP., http://www.100md.com(李雪姣 许成芳)
【关键词】盆底康复治疗；压力性尿失禁；盆腔器官脱垂；盆底肌纤维肌力
【Abstract】ObjectiveTo evaluate the long-term efficacy of postpartum pelvic floor rehabilitation treatment on the pelvic floor function at 3 years after delivery. MethodsDuring the return visit at 2 months after delivery， the stress urinary incontinence (SUI) questionnaire was distributed and the pelvic floor muscular strength score was assessed by pelvic organ prolapse quantification (POP-Q). All women were divided into the treatment and control groups according to their willingness. Patients in the treatment group received comprehensive pelvic floor rehabilitation treatment and were instructed to take pelvic floor muscle exercises for a long time after the rehabilitation therapy. No guidance or instructions were delivered in the control group. After 3 years， all patients were followed up by telephone and the SUI was assessed. All participants were encouraged to pay a return-visit. POP-Q and pelvic floor muscle strength scores were evaluated. The SUI score， the incidence of POP and the improvement of pelvic floor muscle strength were statistically compared between two groups. ResultsA total of 444 women were enrolled including 101 in the treatment group and 343 in the control group (SUI data by telephone follow-up). In the treatment group， 45 cases and 49 in the control group (POP-Q and pelvic floor muscle strength evaluation data) attended the 3-year follow-up. At 2 months after delivery， the incidence of POP and pelvic floor muscle strength did not significantly differ between two groups(both P>0.05). Prior to corresponding treatment， the incidence of SUI and POP and the distribution of type Ⅰ and Ⅱ pelvic floor muscle strength did not significantly differ between two groups (all P>0.05). At 3 years after treatment， the incidence of SUI were significantly decreased and the type Ⅰ and Ⅱ pelvic floor muscle strength were significantly enhanced in both groups (all P<0.01). There were no significantly change of the incidence of POP in both groups (all P>0.05). The incidence decrease of SUI and POP did not significantly differ between two groups (both P>0.05). In the treatment group， type Ⅰ and Ⅱ pelvic floor muscle strength was significantly improved compared with that in the control group (both P<0.01). ConclusionPostpartum pelvic floor rehabilitation treatment yields long-term efficacy in enhancing the pelvic floor muscle strength， whereas it fails to reduce the incidence of SUI and POP., http://www.100md.com(李雪姣 许成芳)