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中华疝和腹壁外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 183 -189. doi: 10.3877/cma.j.issn.1674-392X.2026.02.011

论著

膀胱低频电刺激联合针灸治疗盆腔器官脱垂手术后尿潴留疗效观察
杨旎1, 王素美1,†(), 马懿迪1, 谢衡辉2, 梁兵1, 孙晶晶1, 张倩1, 李华1,†()   
  1. 1100020　首都医科大学附属北京朝阳医院妇产科
    2100020　首都医科大学附属北京朝阳医院中医科
  • 收稿日期:2026-03-03 出版日期:2026-04-18
  • 通信作者: 王素美, 李华
  • 基金资助:
    北京市科委-科技新星交叉课题(202504841004)

Observation on the therapeutic effect of low-frequency electrical stimulation of the bladder combined with acupuncture in the treatment of postoperative urinary retention after pelvic organ prolapse surgery

Ni Yang1, Sumei Wang1,†(), Yidi Ma1, Henghui Xie2, Bing Liang1, Jingjing Sun1, Qian Zhang1, Hua Li1,†()   

  1. 1Department of Obstetrics and Gynecology, Chao Yang Hospital, Capital Medical University, Beijing 100020, China
    2Department of Traditional Chinese Medicine, Chao Yang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2026-03-03 Published:2026-04-18
  • Corresponding author: Sumei Wang, Hua Li
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引用本文：

杨旎, 王素美, 马懿迪, 谢衡辉, 梁兵, 孙晶晶, 张倩, 李华. 膀胱低频电刺激联合针灸治疗盆腔器官脱垂手术后尿潴留疗效观察[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(02): 183-189.

Ni Yang, Sumei Wang, Yidi Ma, Henghui Xie, Bing Liang, Jingjing Sun, Qian Zhang, Hua Li. Observation on the therapeutic effect of low-frequency electrical stimulation of the bladder combined with acupuncture in the treatment of postoperative urinary retention after pelvic organ prolapse surgery[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2026, 20(02): 183-189.

目的

探究膀胱低频电刺激（LFES）及其联合针灸治疗盆腔器官脱垂（POP)手术后尿潴留（POUR）的效果。

方法

本研究为单中心回顾性队列研究。选择2018年1月—2025年12月于首都医科大学附属北京朝阳医院妇产科行盆底重建术或阴道闭合术患者817例，术后留置导尿48~72 h，拔除尿管后排尿困难或排尿不畅，残余尿量（PVR）≥100 ml，以及无法自主排尿需要再次留置尿管诊断为POUR的90例作为研究对象。医师根据病情及患者意愿选择治疗方法，依据治疗方法分为保留导尿组（n=34）、LFES＋保留导尿组（n=31）、针灸＋LFES＋保留导尿组（n=21）、保留导尿＋针灸组（n=4）。治疗48 h后再次拔出导尿管测PVR<100 ml为首次治疗成功。分析POUR患者的整体情况、首次治疗效果的影响因素，比较各组疗效。

结果

90例POUR患者平均年龄（68.7±7.9）岁；盆腔器官脱垂定量分期（POP-Q）均为Ⅲ~Ⅳ期，其中前盆腔脱垂83例（92.2%）；术前尿潴留84例（93.0%）。针灸＋保留导尿组仅完成4例，中断研究，未行对比分析。其余3组POUR患者比较，针灸＋LFES＋保留导尿组术前尿潴留病程及POP-Q分期Ⅳ期、阴道闭合术、同时切除子宫或行TVT的患者比例均显著高于保留导尿组及LFES＋保留导尿组（P<0.05）。三组总体首次治疗成功率80.2%（69/86）。首次治疗失败组较首次治疗成功组中位残余尿量更多、尿管留置时间更长，差异均有统计学意义（P<0.05）。首次治疗失败组患者脱垂最重部位均在前盆腔，高于首次治疗成功组（89.9%），但两组比较，差异无统计学意义（P>0.05）。后续予LFES联合针灸治疗均痊愈。保留导尿组、LFES＋保留导尿组、针灸＋LFES＋保留导尿组首次治疗成功率分别为88.2%（30/34）、77.4%（24/31）、71.4%（15/21），差异无统计学意义（P=0.279）。

结论

重度（POP-Q Ⅲ~Ⅳ期）前盆腔脱垂伴长期尿潴留、年老体弱、复杂盆底手术可能是POUR的高危因素。残余尿量多、尿管留置时间长可能是治疗效果的影响因素。针灸＋LFES＋保留导尿联合应用于POUR病情较重的患者，可达到与单纯导尿及LFES联合导尿对POUR病情较轻患者相同的疗效。但此结论仍需多中心前瞻性随机对照研究进一步验证。

关键词: 盆腔器官脱垂, 手术后尿潴留, 低频电刺激, 针灸
Objective

To investigate the efficacy of low-frequency electrical stimulation (LFES) of the bladder and its combination with acupuncture in the treatment of postoperative urinary retention (POUR) following pelvic organ prolapse(POP) surgery.

Methods

This was a single-center retrospective cohort study. A total of 817 patients who underwent pelvic floor reconstructive surgery or colpocleisis in the Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, from January 2018 to December 2025 were enrolled. Among them, 90 patients were selected as study subjects who developed POUR after indwelling catheterization for 48-72 hours postoperatively, characterized by dysuria, poor urinary flow, post-void residual urine volume (PVR)≥100 ml, or inability to void spontaneously requiring re-catheterization. Treatment modalities were selected by physicians based on disease conditions and patient preferences. According to the treatment methods, patients were divided into four groups: indwelling catheterization group (n=34), LFES+indwelling catheterization group (n=31), acupuncture+LFES+indwelling catheterization group (n=21), and indwelling catheterization+acupuncture group (n=4). Successful initial treatment was defined as PVR<100 ml after catheter removal 48 hours post-treatment. The general characteristics of POUR patients, influencing factors of initial treatment efficacy, and treatment outcomes among groups were analyzed.

Results

The mean age of the 90 POUR patients was (68.7±7.9) years. All patients had pelvic organ prolapse quantification (POP-Q) of stage Ⅲ-Ⅳ, including 83 cases (92.2%) of anterior pelvic prolapse; 84 cases (93.0%) had preoperative urinary retention. The acupuncture + indwelling catheterization group included only 4 completed cases and discontinued study without comparative analysis. Among the remaining three groups, the acupuncture+ LFES+ indwelling catheterization group had significantly higher proportions of patients with longer preoperative urinary retention duration, POP-Q stage Ⅳ, vaginal closure surgery, concurrent hysterectomy, or tension-free vaginal tape (TVT) procedure than the indwelling catheterization group and LFES+indwelling catheterization group (P<0.05). The overall initial treatment success rate of the three groups was 80.2% (69/86). Compared with the initial treatment success group, the failure group had a higher median PVR and longer catheter indwelling time, with statistically significant differences (P<0.05). All patients in the failure group had the most severe prolapse at the anterior pelvic compartment, which was higher than 89.9% in the success group, but the difference was not statistically significant (P>0.05). All patients with initial treatment failure recovered after subsequent LFES combined with acupuncture treatment. The initial treatment success rates of the indwelling catheterization group, LFES+indwelling catheterization group, and acupuncture+LFES+indwelling catheterization group were 88.2% (30/34), 77.4% (24/31), and 71.4% (15/21), respectively, with no statistically significant difference (P=0.279).

Conclusion

Severe anterior pelvic prolapse (POP-Q stage Ⅲ-Ⅳ) with long-term urinary retention, advanced age and poor physical condition, and complex pelvic floor surgery may be high-risk factors for POUR. High PVR and prolonged catheter indwelling time may affect treatment efficacy. The combined therapy of LFES, acupuncture and indwelling catheterization achieves comparable efficacy in patients with severe POUR to that of simple catheterization and LFES plus catheterization in patients with mild POUR. However, this conclusion still needs to be further verified by multicenter prospective randomized controlled trials.

Key words: Pelvic organ prolapse, Postoperative urinary retention, Low-frequency electrical stimulation, Acupuncture
表1 盆底手术后发生尿潴留的盆腔器官脱垂患者的一般资料及手术资料（n=90）
项目 数值
年龄(岁, ±s) 68.7±7.9
体重指数[kg/m2,M(Q1,Q3)] 24.4(23.0,25.9)
孕次[次,M(Q1,Q3)] 3.0(2.0,3.5)
产次[次,M(Q1,Q3)] 2.0(1.0,2.0)
脱垂病程[年,M(Q1,Q3)] 2.0(1.0,4.8)
术前尿潴留病程[月,M(Q1,Q3)] 0.0(0.0,3.0)
POP-Q分期[例(%)]  
Ⅲ期 32(35.6)
Ⅳ期 58(64.4)
脱垂最重部位[例(%)]  
前盆腔 83(92.2)
中盆腔 7(7.8)
手术时间[h,M(Q1,Q3)] 3.4(1.2,4.1)
术中出血[ml,M(Q1,Q3)] 80(50,100)
手术方式[例(%)]  
经阴道植入网片盆底重建术 38(42.2)
经腹腔镜植入网片盆底重建术 20(22.2)
自体组织盆底重建术 11(12.2)
阴道闭合术 21(23.3)
同时行TVT[例(%)] 42(46.7)
同时切除子宫[例(%)] 36(40.0)
残余尿量[ml,M(Q1,Q3)] 268(167,411)
保留尿管时间[d,M(Q1,Q3)] 5.0(3.0,7.0)
表2 采用不同治疗方法的3组术后尿潴留患者一般情况及手术情况比较
项目 保留导尿组(n=34) LFES+保留导尿组(n=31) 针灸+LFES+保留导尿组(n=21) 统计量 P值
年龄(岁, ±s) 67.9±8.3 67.2±7.9 70.7±6.7 1.325d 0.271
体重指数[kg/m2,M (Q1,Q3)] 24.2(22.5,25.4) 25.3(23.0,26.1) 24.4(23.4,25.4) 1.850e 0.397
孕次[次,M (Q1,Q3)] 3.0(2.0,3.0) 3.0(2.0,3.0) 3.0(2.0,4.0) 0.700e 0.705
产次[次,M (Q1,Q3)] 1.0(1.0,2.0) 2.0(1.0,2.0) 2.0(1.0,3.0) 3.036e 0.219
脱垂病程[年,M (Q1,Q3)] 2.0(0.6,5.0) 2.0(1.0,3.0) 3.0(1.5,5.0) 2.348e 0.309
术前尿潴留病程[月,M (Q1,Q3)] 0.0(0.0,0.8) 0.0(0.0,3.0) 3.0(2.0,6.0) ab 22.360e <0.001
POP-Q分期Ⅳ期[例(%)] 19(55.9) 16(51.6) 20(95.2)ac 11.924f 0.003
脱垂最重部位[例(%)]          
前盆腔 32(94.1) 28(90.3) 19(90.5) 0.384f 0.782
中盆腔 2(5.9) 3(9.7) 2(9.5) 0.384f 0.793
手术时间[h,M (Q1,Q3)] 3.6(1.3,3.6) 3.7(3.0,4.0) 3.1(2.8,4.5) 0.107e 0.948
术中出血量[ml,M (Q1,Q3)] 50(50,100) 50(50,100) 100(80,150) b 12.323e 0.002
手术方式[例(%)]          
经阴道植入网片盆底重建术 14(41.2) 18(58.1) 4(19.0)b 7.842f 0.020
经腹腔镜植入网片盆底重建术 10(29.4) 7(22.6) 3(14.3) 1.677f 0.432
自体组织盆底重建术 7(20.6) 1(3.2) 2(9.5) 4.877f 0.112
阴道闭合术 3(8.8) 5(16.1) 12(57.1)ac 18.362f <0.001
同时TVT 12(35.3) 11(35.5) 16(76.2)ac 10.664f 0.005
同时切除子宫 10(29.4) 8(25.8) 16(76.2)ac 15.705f <0.001
残余尿量[ml,M (Q1,Q3)] 191(131,300) 300(200,417) 400(200, 550) 7.214e 0.027
保留尿管时间[d,M (Q1,Q3)] 3.0(3.0,5.0) 6.0(3.0,7.0) 5.0(3.0,10.0) 7.806e 0.020
表3 术后尿潴留患者首次治疗效果影响因素分析
项目 首次治疗成功组(n=69) 首次治疗失败组(n=17) 统计量 P值
年龄(岁, ±s) 67.9±8.0 70.0±7.3 -0.990a 0.325
体重指数[kg/m2,M (Q1,Q3)] 24.0(22.5,26.0) 25.4(24.4,25.9) 414.0b 0.062
孕次[次,M (Q1,Q3)] 3.0(2.0,3.0) 2.0(2.0,3.0) 582.0b 0.809
产次[次,M (Q1,Q3)] 2.0(1.0,2.0) 2.0(1.0,2.0) 552.5b 0.843
脱垂病程[年,M (Q1,Q3)] 2.0(1.0,5.0) 2.0(1.0,6.0) 549.5b 0.690
术前尿潴留病程[月,M (Q1,Q3)] 0.0(0.0,3.0) 0.0(0.0,3.0) 635.0b 0.569
POP-Q分期[例(%)]     0.005c 0.942
Ⅲ期 25(36.2) 6(35.3)    
Ⅳ期 44(63.8) 11(64.7)    
手术时间[h,M (Q1,Q3)] 3.5(3.0,4.1) 3.1(2.8,3.8) 651.0b 0.487
术中出血[ml,M (Q1,Q3)] 100(50,100) 80(50,100) 625.0b 0.636
脱垂最重部位[例(%)]     1.877c 0.336
前盆腔 62(89.9) 17(100)    
中盆腔 7(10.1) 0(0.0)    
伴网片前盆腔重建术[例(%)] 42(60.9) 14(82.4) 1.906c 0.167
经阴道 27(64.3) 9(64.3) 0.000c 0.223
经腹腔镜 15(35.7) 5(35.7) 0.000c 0.352
自体组织前盆腔重建术[例(%)] 27(39.1) 3(17.6) 0.162c 0.679
同时TVT[例(%)] 29(42.0) 10(58.8) 0.949c 0.330
同时切除子宫[例(%)] 29(42.0) 5(29.4) 0.908c 0.252
残余尿量[ml,M (Q1,Q3)] 248(142,400) 412(251,550) 369.5b 0.019
保留尿管时间[d,M (Q1,Q3)] 3.0(3.0,5.0) 10.0(8.0,14.0) 83.0b <0.001
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