骨盆鬆弛症候群婦女接受骨盆重建術前的症狀困擾及生活衝擊

The Life Impacts and Symptom Distress in Women With Pelvic Organ Prolapse Syndrome Before Pelvic Reconstruction Surgery

10.6224/JN.000007

柯逸貞(I-Chen Ko)；盧佳序(Tsia-Shu Lo)；盧玉嬴(Yu-Ying Lu)；曹麗英(Lee-Ing Tsao)

婦女健康 ； 骨盆鬆弛症候群 ； 骨盆重建術 ； 生活衝擊 ； 症狀困擾 ； women health ； pelvic organ prolapse syndrome ； pelvic reconstructive surgery ； lifestyle impact ； symptom distress

護理雜誌

64卷1期（2017 / 02 / 01）

41 - 50

繁體中文

背景　接受骨盆重建術是骨盆鬆弛症候群婦女很難做的抉擇，然而國內少有研究探討這些婦女在手術前之症狀困擾及生活衝擊。婦科護理人員有必要瞭解骨盆底肌無力造成骨盆腔承載的內臟器官脫垂，對她們身心健康及生活等造成的影響。目的　瞭解骨盆鬆弛症候群婦女接受骨盆重建術前的症狀困擾及生活衝擊情況與程度，並探討此二主題之相關性及預測因子。方法　本研究採橫斷式研究，以結構式問卷進行資料收集。研究對象為北區某醫學中心住院接受骨盆重建手術之婦女，共收集110份問卷。結果　本研究對象婦女之泌尿道症狀最嚴重的困擾為日間頻尿，骨盆症狀最嚴重的困擾為感覺陰道有突出物，生活衝擊最嚴重的情況為因相關症狀而感到焦慮、憂鬱或緊張。經統計分析顯示，泌尿道症狀困擾越高其骨盆症狀困擾程度越高。而泌尿道症狀困擾程度與骨盆症狀困擾程度越多，其生活衝擊亦越高。又樣本之教育程度與骨盆症狀，可預測其對生活衝擊之影響。結論／實務應用　骨盆鬆弛症候群的病人宜注意其日間頻尿與陰道突出物之症狀困擾，及需注意因症狀造成之情緒焦慮憂鬱困擾之情形。護理人員照護骨盆鬆弛症候群的病人，除了評估其於泌尿道與骨盆症狀困擾外，宜考量病人的教育程度及骨盆症狀兩項因素對其生活衝擊之影響。

Background: The decision whether or not to undergo pelvic reconstructive surgery is difficult for women suffering from pelvic organ prolapse. However, little research has examined the symptom distress and life impacts that these women face prior to this surgery. Thus, it is crucial that gynecology nurses learn about these life impacts and symptom distresses in order to help these women make the best decisions with regard to surgery. Purpose: To explore the life impacts and degree of symptom distress in pre-surgery women with pelvic organ prolapse; to explore the relationships between demographic data and the variables of life impact and degree of symptom distress; and to identify the factors that relate to the explainable variance in the life impacts of these women. Methods: A cross-sectional and correlational research design was used and a total of 110 women with pelvic organ prolapse who had not yet undergone pelvic reconstruction surgery were recruited in the gynecological clinics of one medical center in Taiwan. Results: Daytime urination frequency was the most prevalent urinary tract symptom noted by the participants; vaginal protrusion was the most prevalent pelvis-related symptom noted; and depression and anxiety were the most prevalent life impacts noted. Moreover, greater lower-urinary-tract symptom distress was associated with greater pelvic-symptom distress. Furthermore, greater lower urinary tract and pelvic symptom distresses were associated with a greater negative impact on life. Education background and pelvis-related symptoms were the explained variances in pre-surgery life impacts. Conclusions: Women with pelvic organ prolapse should pay particular attention to symptoms that include: daytime urinary frequency, vaginal protrusion, and emotional problems including depression and anxiety. Education background and level of symptom distress should be taken into consideration when caring for the life impacts of this vulnerable group of women.

1. 生活（2015）．於教育部重編國語辭典修訂本．取自http://dict.revised.moe.edu.tw/cgi-bin/cbdic/gsweb.cgi?o=dcbdic&searchid=Z00000132387 [Life. (2015). In the Ministry of Education Renumbering the Mandarin Dictionary Amendment, Taiwan, ROC. Retrieved from http://dict.revised.moe.edu.tw/cgi-bin/cbdic/gsweb.cgi?o=dcbdic&searchid=Z00000132387]
2. 內政部統計處（2016）．平均餘命查詢．取自http://statdb.dgbas.gov.tw/pxweb/Dialog/Saveshow.asp [Department of Statistics, Ministry of the Interior, Taiwan, ROC. (2016). Average life expectancy. Retrieved from http://statdb.dgbas.gov.tw/pxweb/Dialog/Saveshow.asp]
3. 衝擊（2015）．於教育部重編國語辭典修訂本．取自http://dict.revised.moe.edu.tw/cgi-bin/cbdic/gsweb.cgi?o=dcbdic&searchid=Z00000126735 [Impact. (2015). In the Ministry of Education Renumbering the Mandarin Dictionary Amendment, Taiwan, ROC. Retrieved from http://dict.revised.moe.edu.tw/cgi-bin/cbdic/gsweb.cgi?o=dcbdic&searchid=Z00000126735]
4. Bader, T. J.(2003).OB/GYN secrets.Philadelphia, PA:Hanley & Belfus.
5. Basu, M.,Wise, B.,Duckett, J.(2011).A qualitative study of women's preferences for treatment of pelvic floor disorders.BJOG: An International Journal of Obstetrics & Gynaecology,118(3),338-344.
6. Burrows, L. J.,Meyn, L. A.,Walters, M. D.,Weber, A. M.(2004).Pelvic symptoms in women with pelvic organ prolapse.Obstetrics & Gynecology,104(5, Pt.1),982-988.
7. Cetinkaya, S. E.,Dokmeci, F.,Dai, O.(2013).Correlation of pelvic organ prolapse staging with lower urinary tract symptoms, sexual dysfunction, and quality of life.International Urogynecology Journal,24(10),1645-1650.
8. Chan, S. S. C.,Cheung, R. Y. K.,Yiu, K. W.,Lee, L. L.,Pang, A. W. L.,Chung, T. K. H.(2012).Symptoms, quality of life, and factors affecting women's treatment decisions regarding pelvic organ prolapse.International Urogynecology Journal,23(8),1027-1033.
9. Chang, S. J.,Tai, H. L.,Chen, G. D.,Chen, S. Y.(2006).Effects of a pelvic floor muscle training program for women with urinary incontinence.Journal of the Urological Association,17(4),128-135.
10. Cohen, J.(1988).Statistical power analysis for the behavioral sciences.Hillsdale, NJ:Erlbaum.
11. Digesu, G. A.,Chaliha, C.,Salvatore, S.,Hutchings, A.,Khullar, V.(2005).The relationship of vaginal prolapse severity to symptoms and quality of life.BJOG: An International Journal of Obstetrics & Gynaecology,112(7),971-976.
12. Ellerkmann, R. M.,Cundiff, G. W.,Melick, C. F.,Nihira, M. A.,Leffler, K.,Bent, A. E.(2001).Correlation of symptoms with location and severity of pelvic organ prolapse.AJOG: American Journal of Obstetrics & Gynecology,185(6),1332-1338.
13. Fritel, X.,Varnoux, N.,Zins, M.,Breart, G.,Ringa, V.(2009).Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors.Obstetrics & Gynecology,113(3),609-616.
14. Handa, V. L.,Cundiff, G.,Chang, H. H.,Helzlsouer, K. J.(2008).Female sexual function and pelvic floor disorders.Obstetrics & Gynecology,111(5),1045-1052.
15. Karabulut, A.,Ozkan, S.,Koçak, N.,Alan, T.(2014).Evaluation of confounding factors interfering with sexual function in women with minimal pelvic organ prolapse.International Journal of Gynecology & Obstetrics,127(1),73-76.
16. Kuncharapu, I.,Majeroni, B. A.,Johnson, D. W.(2010).Pelvic organ prolapse.American Family Physician,81(9),1111-1117.
17. Long, C. Y.,Hsu, C. S.,Wu, M. P.,Lo, T. S.,Liu, C. M.,Tsai, E. M.(2011).Comparison of changes in sexual function of premenopausal and postmenopausal women following transvaginal mesh surgery.The Journal of Sexual Medicine,8(7),2009-2016.
18. Lowder, J. L.,Ghetti, C.,Nikolajski, C.,Oliphant, S. S.,Zyczynski, H. M.(2011).Body image perceptions in women with pelvic organ prolapse: A qualitative study.AJOG: American Journal of Obstetrics & Gynecology,204(5),441.el-441.e5.
19. Lynn, M. R.(1986).Determination and quantification of content validity.Nursing Research,35(6),382-386.
20. Mouritsen, L.,Larsen, J. P.(2003).Symptoms, bother and POPQ in women referred with pelvic organ prolapse.International Urogynecology Journal,14(2),122-127.
21. Roos, A. M.,Thakar, R.,Sultan, A. H.,Burger, C. W.,Paulus, A. T. G.(2014).Pelvic floor dysfunction: Women's sexual concerns unraveled.The Journal of Sexual Medicine,11(3),743-752.
22. Slieker-ten Hove, M. C. P.,Pool-Goudzwaard, A. L.,Eijkemans, M. J. C.,Steegers-Theuniseen, R. P. M.,Burger, C. W.,Vierhout, M. E.(2009).The prevalence of pelvic organ prolapse symptoms and sign and their relation with bladder and bowel disorders in a general female population.International Urogynecology Journal,20(9),1037-1045.
23. Tok, E. C.,Yasa, O.,Ertunc, D.,Savas, A.,Durukan, H.,Kanik, A.(2010).The effect of pelvic organ prolapse on sexual function in a general cohort of women.The Journal of Sexual Medicine,7(12),3957-3962.
24. Waltz, C. F.,Bausell R. B.(1983).Nursing research: Design, statistics and computer analysis.Philadelphia, PA:F. A. Davis.
25. Wang, Y. H.,Chen, S. H.,Jou, H. J.,Tsao, L. I.(2011).Doing the best to control: The experiences of Taiwanese women with lower urinary tract symptoms.Nursing Research,60(1),66-72.
26. Weber, A. M.,Walters, M. D.,Schover, L. R.,Mitchinson, A.(1995).Sexual function in women with uterovaginal prolapse and urinary incontinence.Obstetrics & Gynecology,85(4),483-487.
27. Wren, P. A.,Janz, N. K.,Brubaker, L.,Fitzgerald, M. P.,Weber, A. M.,LaPorte, F. B.,Wei, J. T.(2005).Reliability of health-related quality-of-life measures 1 year after surgical procedures for pelvic floor disorders.AJOG: American Journal of Obstetrics & Gynecology,192(3),780-788.
28. Zielinski, R.,Miller, J.,Low, L. K.,Sampselle, C.,DeLancey, J. O. L.(2012).The relationship between pelvic organ prolapse, genital body image, and sexual health.Neurourology and Urodynamics,31(7),1145-1148.
29. 台灣尿失禁防治協會、郭漢崇、林登龍(2005)。婦女泌尿學。台北市=Taipei City, Taiwan, ROC:藝軒圖書=Yi Hsien Publishing。
30. 黃君怡(2013)。高雄市，高雄醫學大學護理學研究所=Kaohsiung Medical University。
31. 黃惠美、趙湘台、林寬佳、鄭素月、廖媛美(2010)。45-60歲婦女之更年期症狀與生活品質相關因素研究。新臺北護理期刊，12(1)，7-20。
32. 蔡娟秀、郭漢崇、林登龍(2005)。骨盆底功能障礙與治療。台中市=Taichung City, Taiwan, ROC:台灣尿失禁防治協會=Taiwanese Continence Society。
33. 龍震宇、謝佳芬、陳世琴、林冠伶、陳可欣、劉正民、蔡英美(2012)。以人工網膜行骨盆器官重建手術對性功能之影響。臺灣醫界，55(9)，14-16。

1. 蔡娟秀、張綠怡、呂基燕(2017)。骨盆健康—婦女與醫療觀點之保健需求。護理雜誌，64(2)，12-18。
2. 葉惠玲,黃子芸(2021)。照顧一位婦女應力性尿失禁術後併發急尿感個案之護理經驗。彰化護理，28(4)，133-144。