How accurate is symptomatic and clinical evaluation of prolapse prior to surgical repair?
How accurate is symptomatic and clinical evaluation of prolapse prior to surgical repair?
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手术修复前脱垂的症状和临床评估有多准确？
DOI：
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发表时间：
2007
影响因子：
1.8
通讯作者：
Anthony R.B. Smith
中科院分区：
文献类型：
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作者：
A. Fayyad;S. Hill;V. Gurung;S. Prashar;Anthony R.B. Smith
本研究的目的是评估盆腔器官脱垂的术前评估的准确性。该设计是一项设置在英国教学医院妇科的前瞻性观察性审计。该人群由接受脱垂手术的患者组成。104名因脱垂手术入院的患者参加了审计。患者的笔记最初在临床上被审查脱垂评估的充分性。然后，研究人员对患者进行采访，并使用有效的脱垂生活质量(P-QOL)问卷进行评估。注意到存在未记录的症状。在麻醉下在手术室进行脱垂检查，并与临床结果进行比较，并将手术结果与拟议的手术进行比较。结果测量如下：(1)比较临床记录和P-QOL问卷条目时，术前准确评估脱垂症状的患者数量；(2)术前未准确评估与盆腔器官脱垂相关的症状的患者数量；(3)术前和术中检查脱垂的差异(如果有)。我们队列中的16名患者(15%)在手术前对他们的脱垂有足够的评估。没有得到充分评估的症状按降序排列为脱垂对生活质量(76%)、性功能(75%)、肠功能(27%)和下尿路症状(12.5%)的影响。31例(30%)有性功能障碍，24例(23%)有肠道症状，23例(22%)有术前未记录的尿路症状。脱垂的体检在59%的病例中是足够的。38例(37%)术中检查与临床检查结果不一致；16例(42%)脱垂程度大于或小于笔记所述；11例(29%)脱垂位于不同的阴道间隔。另有11例(29%)同时存在这两种情况(即不同程度的脱垂和位于不同阴道室的脱垂)。2 1%的病例(n = 2 2)的手术方式与临床建议的不同。临床对阴道脱垂患者的评估和检查往往不够充分。临床环境下的脱垂体检可能与麻醉下的检查结果不同。这可能会影响修复脱垂的手术。当病人登记接受手术时，应该就这一点给予咨询。
The aim of this study is to assess the accuracy of pre-operative evaluation of pelvic organ prolapse. The design is a prospective observational audit set at the gynaecology department, Teaching Hospital, UK. The population is composed of patients undergoing surgery for prolapse. One hundred and four patients admitted for prolapse surgeries were enrolled in the audit. Patients’ notes were initially reviewed for adequacy of prolapse assessment in the clinic. Patients were then interviewed by the researchers and assessed using a validated Prolapse Quality of Life (P-QOL) questionnaire. The presence of unrecorded symptoms was noted. Prolapse examination in theatre under anaesthesia was compared to the findings in the clinic and the operation performed compared to the proposed operation. The outcome measures were as follows: (1) number of patients who had accurate prolapse symptom assessment before surgery when comparing clinical records with entries on P-QOL questionnaires; (2) number of patients having symptoms related to their pelvic organ prolapse that were not accurately assessed pre-operatively; and (3) the differences, if any, between pre-operative and intra-operative examination of prolapse. Sixteen patients in our cohort (15%) had adequate assessment of their prolapse pre-operatively. Symptoms that were not adequately assessed in descending order were the impact of prolapse on quality of life (76%), sexual function (75%), bowel function (27%) and lower urinary tract symptoms (12.5%). Thirty one patients (30%) had sexual dysfunction, 24 (23%) had bowel symptoms and 23 patients (22%) had urinary symptoms that were not recorded before surgery. Prolapse physical examination was adequate in 59% of the cases. Examinations in theatre were different from clinic findings in 38 cases (37%); 16 cases (42%) had a greater or lesser degree of prolapse than that described in the notes; and 11 cases (29%) had prolapse in a different compartment in the vagina. A combination of both (i.e. different degree of prolapse and prolapse in a different vaginal compartment) was found in another 11 cases (29%). The operation performed was different from the one proposed in the clinic in 21% of the cases (n = 22). Clinical evaluation and examination of patients with vaginal prolapse is often inadequate. Prolapse physical examination in a clinic setting could be different from findings under anaesthesia. This can affect the operation to repair the prolapse. Patients should be counselled about this when listed for surgery.