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女性尿失禁和盆腔器官脱垂管理指南(下) | 2019 NICE

作者: 单位: 来源:医脉通泌尿外科 编者:
2020-3-4 阅读

盆腔器官脱垂的评估


For women presenting in primary care with symptoms or an incidental finding of vaginal prolapse: Take a history to include symptoms of prolapse, urinary, bowel and sexual function. Do an examination to rule out a pelvic mass or other pathology and to document the presence of prolapse. Discuss the woman's treatment preferences with her, and refer if needed. 


对于在初级保健中出现症状或偶然发现阴道脱垂的女性:请记录包括脱垂、尿路、肠道和性功能症状。进行检查以排除盆腔肿块或其他病状,并记录脱垂的存在。与患者讨论其治疗偏好,如果需要的话可以参考。


For women referred to secondary care for an unrelated condition who have incidental symptoms or an incidental finding of vaginal prolapse, consider referral to a clinician with expertise in prolapse.


对于二级医疗机构出现偶发阴道脱垂无法治疗的女性,请转诊到脱垂专科医疗机构。


For women who are referred for specialist evaluation of vaginal prolapse, perform an examination to: assess and record the presence and degree of prolapse of the anterior, central and posterior vaginal compartments of the pelvic floor, using the POP-Q (Pelvic Organ Prolapse Quantification) system. Assess the activity of the pelvic floor muscles. Assess for vaginal atrophy. Rule out a pelvic mass or other pathology. 


转诊至阴道脱垂专科机构的女性,请进行以下检查:使用POP-Q(盆腔器官脱垂量表)评估,并记录盆底前、中、后阴道腔室脱垂的存在情况和严重程度。评估盆底肌肉活动。评估阴道萎缩程度。排除盆腔肿块或其他病状。


For women with pelvic organ prolapse, consider using a validated pelvic floor symptom questionnaire to aid assessment and decision making. Do not routinely perform imaging to document the presence of vaginal prolapse if a prolapse is detected by physical examination. If the woman has symptoms of prolapse that are not explained by findings from a physical examination, consider repeating the examination with the woman standing or squatting, or at a different time.


对于盆腔器官脱垂女性,请使用经验证的盆底症状问卷帮助评估和决策。如经体检发现脱垂,切勿例行影像检查以证实阴道脱垂的存在。如果女性有脱垂症状,但不能用体检结果解释,可考虑再次检查,让女性站立或蹲下,或在不同时间点检查。


Consider investigating the following symptoms in women with pelvic organ prolapse: urinary symptoms that are bothersome and for which surgical intervention is an option. Aymptoms of obstructed defaecation or faecal incontinence. Pain. Symptoms that are not explained by examination findings. 


研究脱垂女性的以下症状:可选择手术治疗的严重泌尿症状。大便阻塞或大便失禁症状。疼痛。检查结果无法解释的症状。


非手术疗法


Discuss management options with women who have pelvic organ prolapse, including no treatment, non-surgical treatment and surgical options, taking into account: The woman's preferences, site of prolapse, lifestyle factors, comorbidities, including cognitive or physical impairments, age, desire for childbearing, previous abdominal or pelvic floor surgery, benefits and risks of individual procedures. 


在选择治疗方案时(包括不处理、非手术疗法和手术方案),应综合考虑:女性偏好、脱垂部位、生活方式、合并症(包括认知或身体损伤)、年龄、生育欲望、腹部或盆底手术史、手术收益和风险。


Lifestyle modifification losing weight, if the woman has a BMI greater than 30 kg/m2. Minimising heavy lifting. Preventing or treating constipation. 


生活方式调整 如果女性BMI指数>30 kg/m2,则建议减肥。减轻日常负重。预防或治疗便秘。


Pelvic floor muscle training Consider a programme of supervised pelvic floor muscle training for at least 16 weeks as a first option for women with symptomatic POP-Q (Pelvic Organ Prolapse Quantification) stage 1 or stage 2 pelvic organ prolapse. If the programme is beneficial, advise women to continue pelvic floor muscle training afterwards.


盆底肌肉训练 对于POP-Q评分1期或2期的症状性脱垂女性,应将盆底肌肉训练至少16周作为首选方案。如果该方案有益,则建议女性继续盆底肌肉训练。


Consider a vaginal pessary for women with symptomatic pelvic organ prolapse, alone or in conjunction with supervised pelvic floor muscle training. Refer women who have chosen a pessary to a urogynaecology service if pessary care is not available locally. 


子宫托 对于症状性脱垂女性,考虑使用阴道子宫托(单独或与盆底肌肉训练一起使用)。如果在当地无法获得子宫托护理,可转诊到泌尿妇科医疗机构。


Before starting pessary treatment: consider treating vaginal atrophy with topical oestrogen. Explain that more than 1 pessary fitting may be needed to find a suitable pessary. Discuss the effect of different types of pessary on sexual intercourse. Describe complications including vaginal discharge, bleeding, difficulty removing pessary and pessary expulsion. Explain that the pessary should be removed at least once every 6 months to prevent serious pessary complications. 


在采用子宫托治疗前:应考虑使用局部雌激素治疗阴道萎缩。向患者解释可能需要多个子宫托,以找到合适的一个。讨论不同类型的子宫托对性交的影响。描述并发症,包括阴道分泌物、出血、子宫托移除困难和排出。解释子宫托应至少每6个月取出一次,以防止严重的子宫托并发症。


Offer women using pessaries an appointment in a pessary clinic every 6 months if they are at risk of complications, for example because of a physical or cognitive impairment that might make it difficult for them to manage their ongoing pessary care. [2019]


若使用子宫托女性有并发症风险,如因身体或认知障碍,难以掌控正在进行的子宫托护理,请每6个月在子宫托诊所就诊。


盆腔器官脱垂的外科疗法


Explain to women considering surgery for anterior or apical prolapse who do not have incontinence that there is a risk of developing postoperative urinary incontinence and further treatment may be needed.


向考虑手术治疗的前壁脱垂或后壁脱垂女性(无尿失禁)解释,术后有尿失禁的风险,可能需进一步治疗。


For women with uterine prolapse who have no preference about preserving their uterus, offer a choice of: Vaginal hysterectomy, with or without vaginal sacrospinous fixation with sutures or. Vaginal sacrospinous hysteropexy with sutures or. Manchester repair.


对于没有保留子宫意愿的脱垂女性,可选择:经阴道子宫切除术,采用或不采用阴道骶棘缝线固定。采用缝线的阴道骶棘子宫固定术。曼彻斯特修复。


For women with uterine prolapse who wish to preserve their uterus, offer a choice of: Vaginal sacrospinous hysteropexy with sutures or. Manchester repair, unless the woman may wish to have children in the future. Also include the option of sacro-hysteropexy with mesh (abdominal or laparoscopic) in this choice but see recommendation 1.8.6 for specific guidance on the use of mesh in prolapse surgery.


对于希望保留子宫的脱垂女性,可选择:采用阴道骶棘缝线固定。曼彻斯特修复,除非将来想要孩子。采用补片的骶子宫固定术。


医脉通编译整理自:

https://www.nice.org.uk/guidance/ng123/chapter/Recommendations

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