2019 NICE女性尿失禁和盆腔器官脱垂管理指南(下)

2019 NICE女性尿失禁和盆腔器官脱垂管理指南（下）

2019年4月，英国国家卫生与临床优化研究所（NICE）发布了女性尿失禁和盆腔器官脱垂的管理指南，主要内容涵盖了年龄≥18岁女性尿失禁和盆腔器官脱垂的评估和管理，同时也包含相关手术并发症的管理。本指南内容分两次报道，现为第二部分，主要内容为盆腔器官脱垂的评估、非手术疗法和外科疗法。

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。