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   2019年4月，英國國家衛(wèi)生與臨床優(yōu)化研究所（NICE）發(fā)布了女性尿失禁和盆腔器官脫垂的管理指南，主要內(nèi)容涵蓋了年齡≥18歲女性尿失禁和盆腔器官脫垂的評(píng)估和管理，同時(shí)也包含相關(guān)手術(shù)并發(fā)癥的管理。本指南內(nèi)容分兩次報(bào)道，現(xiàn)為第二部分，主要內(nèi)容為盆腔器官脫垂的評(píng)估、非手術(shù)療法和外科療法。

一．盆腔器官脫垂的評(píng)估

1.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. 

   對(duì)于在初級(jí)保健中出現(xiàn)癥狀或偶然發(fā)現(xiàn)陰道脫垂的女性：請(qǐng)記錄包括脫垂、尿路、腸道和性功能癥狀。進(jìn)行檢查以排除盆腔腫塊或其他病狀，并記錄脫垂的存在。與患者討論其治療偏好，如果需要的話可以參考。

2.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.

   對(duì)于二級(jí)醫(yī)療機(jī)構(gòu)出現(xiàn)偶發(fā)陰道脫垂無法治療的女性，請(qǐng)轉(zhuǎn)診到脫垂?？漆t(yī)療機(jī)構(gòu)。

3.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. 

   轉(zhuǎn)診至陰道脫垂?？茩C(jī)構(gòu)的女性，請(qǐng)進(jìn)行以下檢查：使用POP-Q（盆腔器官脫垂量表）評(píng)估，并記錄盆底前、中、后陰道腔室脫垂的存在情況和嚴(yán)重程度。評(píng)估盆底肌肉活動(dòng)。評(píng)估陰道萎縮程度。排除盆腔腫塊或其他病狀。

4.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.

   對(duì)于盆腔器官脫垂女性，請(qǐng)使用經(jīng)驗(yàn)證的盆底癥狀問卷幫助評(píng)估和決策。如經(jīng)體檢發(fā)現(xiàn)脫垂，切勿例行影像檢查以證實(shí)陰道脫垂的存在。如果女性有脫垂癥狀，但不能用體檢結(jié)果解釋，可考慮再次檢查，讓女性站立或蹲下，或在不同時(shí)間點(diǎn)檢查。

5.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. 

   研究脫垂女性的以下癥狀：可選擇手術(shù)治療的嚴(yán)重泌尿癥狀。大便阻塞或大便失禁癥狀。疼痛。檢查結(jié)果無法解釋的癥狀。

二．非手術(shù)療法

1.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. 

   在選擇治療方案時(shí)（包括不處理、非手術(shù)療法和手術(shù)方案），應(yīng)綜合考慮：女性偏好、脫垂部位、生活方式、合并癥（包括認(rèn)知或身體損傷）、年齡、生育欲望、腹部或盆底手術(shù)史、手術(shù)收益和風(fēng)險(xiǎn)。

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

   生活方式調(diào)整 如果女性BMI指數(shù)＞30 kg/m2，則建議減肥。減輕日常負(fù)重。預(yù)防或治療便秘。

3.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.

   盆底肌肉訓(xùn)練 對(duì)于POP-Q評(píng)分1期或2期的癥狀性脫垂女性，應(yīng)將盆底肌肉訓(xùn)練至少16周作為首選方案。如果該方案有益，則建議女性繼續(xù)盆底肌肉訓(xùn)練。

4.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. 

   子宮托 對(duì)于癥狀性脫垂女性，考慮使用陰道子宮托（單獨(dú)或與盆底肌肉訓(xùn)練一起使用）。如果在當(dāng)?shù)責(zé)o法獲得子宮托護(hù)理，可轉(zhuǎn)診到泌尿婦科醫(yī)療機(jī)構(gòu)。

5.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. 

   在采用子宮托治療前：應(yīng)考慮使用局部雌激素治療陰道萎縮。向患者解釋可能需要多個(gè)子宮托，以找到合適的一個(gè)。討論不同類型的子宮托對(duì)性交的影響。描述并發(fā)癥，包括陰道分泌物、出血、子宮托移除困難和排出。解釋子宮托應(yīng)至少每6個(gè)月取出一次，以防止嚴(yán)重的子宮托并發(fā)癥。

6.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]

   若使用子宮托女性有并發(fā)癥風(fēng)險(xiǎn)，如因身體或認(rèn)知障礙，難以掌控正在進(jìn)行的子宮托護(hù)理，請(qǐng)每6個(gè)月在子宮托診所就診。

三．盆腔器官脫垂的外科療法

1.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.

    向考慮手術(shù)治療的前壁脫垂或后壁脫垂女性（無尿失禁）解釋，術(shù)后有尿失禁的風(fēng)險(xiǎn)，可能需進(jìn)一步治療。

2.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.

   對(duì)于沒有保留子宮意愿的脫垂女性，可選擇：經(jīng)陰道子宮切除術(shù)，采用或不采用陰道骶棘縫線固定。采用縫線的陰道骶棘子宮固定術(shù)。曼徹斯特修復(fù)。