老年女性盆腔器官脱垂手术患者合并症分布及多学科诊疗围手术期管理效果分析

doi:10.3877/cma.j.issn.1674-392X.2026.02.015

中华疝和腹壁外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 206 -212. doi: 10.3877/cma.j.issn.1674-392X.2026.02.015

论著

老年女性盆腔器官脱垂手术患者合并症分布及多学科诊疗围手术期管理效果分析

张迪¹, 王素美¹^,^†(

), 陈阳¹, 熊霞鹂¹, 梁兵¹, 白雁飞², 郑雪云¹, 李华¹^,^†(

)

¹100020　首都医科大学附属北京朝阳医院妇产科
²026099　锡林浩特，内蒙古自治区锡林郭勒盟妇幼保健院妇产科

收稿日期:2025-12-29 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)

Analysis of the distribution of comorbidities in elderly female patients undergoing pelvic organ prolapse surgery and the effect of perioperative multidisciplinary team management

Di Zhang¹, Sumei Wang¹^,^†(), Yang Chen¹, Xiali Xiong¹, Bing Liang¹, Yanfei Bai², Xueyun Zheng¹, Hua Li¹^,^†()

¹Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
²Department of Obstetrics and Gynecology, Xilingol League Maternal and Child Health Care Hospital, Inner Mongolia Autonomous Region, Xilinhot City 026099, China

Received:2025-12-29 Published:2026-04-18
Corresponding author: Sumei Wang, Hua Li

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引用本文：

张迪, 王素美, 陈阳, 熊霞鹂, 梁兵, 白雁飞, 郑雪云, 李华. 老年女性盆腔器官脱垂手术患者合并症分布及多学科诊疗围手术期管理效果分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(02): 206-212.

Di Zhang, Sumei Wang, Yang Chen, Xiali Xiong, Bing Liang, Yanfei Bai, Xueyun Zheng, Hua Li. Analysis of the distribution of comorbidities in elderly female patients undergoing pelvic organ prolapse surgery and the effect of perioperative multidisciplinary team management[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2026, 20(02): 206-212.

目的

分析≥65岁老年女性盆腔器官脱垂（POP）手术患者的合并症分布，探讨多学科诊疗（MDT）参与围手术期管理对医疗安全的作用。

方法

采用单中心回顾性队列研究，对2021年1月—2025年12月首都医科大学附属北京朝阳医院妇产科237例POP手术患者的临床资料进行分析，根据是否实施MDT分为MDT组（n=185）与非MDT组（n=52）。分析POP手术患者总体多学科合并症分布情况，并比较两组患者围手术期合并症相关并发症情况。

结果

237例POP患者，中位年龄70（68.0~73.5）岁。合并症包括高血压（62.9%）、冠状动脉狭窄（47.3%）、糖尿病（29.1%）、陈旧性脑梗死（21.9%）、脑血管狭窄（21.1%）、高脂血症需药物治疗（16.5%）、骨关节病（11.4%）、血栓性疾病（6.8%）。其中185例（78.1%）患者经妇科盆底主诊医师初步评估存在严重多学科合并症接受MDT管理。237例POP手术患者，术后81例（34.2%）出现并发症，其中42例（17.7%）为新发血栓性疾病。MDT组患者术后转入外科重症监护病房比例、术后并发症发生率、术后尿潴留发生率、术后住院天数均高于非MDT组[20%比3.8%、38.9%比17.3%、21.1%比7.7%、7（6~9）d比6（5~7）d]，差异均有统计学意义（P<0.05）。但手术时间、术后血红蛋白变化及术后静脉血栓栓塞评分变化、术后新发血栓疾病等指标差异无统计学意义（P>0.05）。

结论

≥65岁的老年女性POP患者常存在多学科合并症，对其进行术前MDT评估，相关学科专家参与围手术期管理，对保障患者的手术安全具有一定意义。

关键词: 盆腔器官脱垂, 老年人, 多学科诊疗, 合并症, 围手术期并发症

Objective

To analyze the distribution of comorbidities in elderly female patients aged ≥65 years undergoing surgery for pelvic organ prolapse (POP), and to explore the role of multidisciplinary team (MDT) participation in perioperative management in ensuring medical safety.

Methods

A single-center retrospective cohort study was conducted to analyze the clinical data of 237 patients who underwent POP surgery at the Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, from January 2021 to December 2025. The patients were divided into the MDT group (n=185) and the non-MDT group (n=52) based on whether MDT was implemented. To analyze the overall distribution of multidisciplinary comorbidities in patients undergoing POP surgery, and to compare perioperative comorbidity-related complications between the two groups of patients.

Results

Among the 237 patients, the median age was 70 (68.0-73.5) years. The comorbidities included hypertension (62.9%), coronary artery stenosis (47.3%), diabetes (29.1%), old cerebral infarction (21.9%), cerebrovascular stenosis (21.1%), taking drugs for hyperlipidemia (16.5%), osteoarthritis (11.4%), and thrombotic diseases (6.8%). Among them, 185 patients (78.1%) were managed by MDT after initial assessment by attending gynecologists specializing in pelvic floor disorders, who identified severe multidisciplinary comorbidities in these patients. Postoperatively, 81 cases (34.2%) of 237 POP surgery patients developed complications, among which 42 cases (17.7%) were new thrombotic diseases. The proportion of patients transferred to the SICU postoperatively, the incidence of postoperative complications, postoperative urinary retention, and the length of postoperative hospital stay were all higher in the MDT group than in the non-MDT group (20.0% vs 3.8%; 38.9% vs 17.3%; 21.1% vs 7.7%; 7(6-9) days vs 6(5-7) days, and the differences were statistically significant (P<0.05). However, no statistically significant differences were observed in surgical time, postoperative changes in hemoglobin levels, venous thromboembolism scores, or the incidence of new thrombotic diseases between two groups (P>0.05).

Conclusion

Elderly women over 65 years old with POP often have multiple comorbidities. Conducting a preoperative MDT assessment for these patients and involving experts from relevant fields in perioperative management are critical to ensuring their surgical safety.

Key words: Pelvic organ prolapse, Elderly, Multidisciplinary team, Comorbidity, Perioperative complications

表1 237例老年盆腔器官脱垂患者多学科合并症情况

内外科合并症	数据
高血压[例(%)]	149(62.9)
高血压年限[年,M(Q₁~Q₃)]	10(4~20)
服用降压药[例(%)]	145(97.3)
糖尿病[例(%)]	69(29.1)
高脂血症并药物治疗[例(%)]	39(16.5)
冠状动脉狭窄[例(%)]	112(47.3)
冠状动脉狭窄不伴支架/球囊[例(%)]	90(80.4)
既往冠状动脉狭窄伴支架/球囊植入[例(%)]	15(13.4)
术前MDT发现冠状动脉狭窄需放支架/球囊[例(%)]	6(5.3)
既往冠脉支架需再次放置球囊[例(%)]	1(0.9)
呼吸系统疾病[例(%)]	16(6.8)
脑血管狭窄[例(%)]	50(21.1)
术前MDT发现颈动脉狭窄需支架植入[例(%)]	1(2.0)
陈旧性脑梗死[例(%)]	52(21.9)
骨关节病[例(%)]	27(11.4)
腰椎间盘疾病[例(%)]	13(48.2)
髋膝关节疾病[例(%)]	9(33.3)
其他[例(%)]	5(18.5)
术前血栓性疾病(肺栓塞及下肢血栓形成)[例(%)]	16(6.8)
恶性肿瘤病史[例(%)]	14(5.9)
外科切除史[例(%)]	154(65.0)
≥2次手术史[例(%)]	60(39.0)
子宫切除手术史[例(%)]	18(11.7)
超重及肥胖(体重指数≥25 kg/m²)[例(%)]	109(46.0)
其他合并症(肝、肾、凝血、免疫、精神疾病等影响手术)[例(%)]	35(14.8)

表1 237例老年盆腔器官脱垂患者多学科合并症情况

内外科合并症	数据
高血压[例(%)]	149(62.9)
高血压年限[年,M(Q₁~Q₃)]	10(4~20)
服用降压药[例(%)]	145(97.3)
糖尿病[例(%)]	69(29.1)
高脂血症并药物治疗[例(%)]	39(16.5)
冠状动脉狭窄[例(%)]	112(47.3)
冠状动脉狭窄不伴支架/球囊[例(%)]	90(80.4)
既往冠状动脉狭窄伴支架/球囊植入[例(%)]	15(13.4)
术前MDT发现冠状动脉狭窄需放支架/球囊[例(%)]	6(5.3)
既往冠脉支架需再次放置球囊[例(%)]	1(0.9)
呼吸系统疾病[例(%)]	16(6.8)
脑血管狭窄[例(%)]	50(21.1)
术前MDT发现颈动脉狭窄需支架植入[例(%)]	1(2.0)
陈旧性脑梗死[例(%)]	52(21.9)
骨关节病[例(%)]	27(11.4)
腰椎间盘疾病[例(%)]	13(48.2)
髋膝关节疾病[例(%)]	9(33.3)
其他[例(%)]	5(18.5)
术前血栓性疾病(肺栓塞及下肢血栓形成)[例(%)]	16(6.8)
恶性肿瘤病史[例(%)]	14(5.9)
外科切除史[例(%)]	154(65.0)
≥2次手术史[例(%)]	60(39.0)
子宫切除手术史[例(%)]	18(11.7)
超重及肥胖(体重指数≥25 kg/m²)[例(%)]	109(46.0)
其他合并症(肝、肾、凝血、免疫、精神疾病等影响手术)[例(%)]	35(14.8)

表2 237例老年盆腔器官脱垂患者盆腔器官脱垂定量分期

诊断	例(%)
中盆腔脱垂	230(97.0)
Ⅰ期	23(10.0)
Ⅱ期	71(30.9)
Ⅲ期	92(40.0)
Ⅳ期	44(19.1)
前盆腔脱垂	231(97.5)
Ⅰ期	8(3.5)
Ⅱ期	26(11.2)
Ⅲ期	93(40.3)
Ⅳ期	104(45.0)
后盆腔脱垂	227(95.8)
Ⅰ期	22(9.7)
Ⅱ期	93(41.0)
Ⅲ期	78(34.3)
Ⅳ期	34(15.0)
盆腔器官脱垂合并尿失禁	86(36.3)

表2 237例老年盆腔器官脱垂患者盆腔器官脱垂定量分期

诊断	例(%)
中盆腔脱垂	230(97.0)
Ⅰ期	23(10.0)
Ⅱ期	71(30.9)
Ⅲ期	92(40.0)
Ⅳ期	44(19.1)
前盆腔脱垂	231(97.5)
Ⅰ期	8(3.5)
Ⅱ期	26(11.2)
Ⅲ期	93(40.3)
Ⅳ期	104(45.0)
后盆腔脱垂	227(95.8)
Ⅰ期	22(9.7)
Ⅱ期	93(41.0)
Ⅲ期	78(34.3)
Ⅳ期	34(15.0)
盆腔器官脱垂合并尿失禁	86(36.3)

表3 237例老年盆腔器官脱垂患者的手术方式

手术方式	例(%)
经阴道盆底重建术	122(51.5)
经阴道子宫切除术/腹腔镜或辅助经阴道子宫切除术	68(28.7)
经阴道骶棘韧带固定术	81(34.2)
经阴道自体组织前盆底重建修补术	72(30.4)
经阴道前盆底重建术(伴网片)	86(36.3)
经阴道自体组织阴道后壁修补术	152(64.1)
腹腔镜盆底重建术	70(29.5)
腹腔镜高位宫骶韧带悬吊术	31(13.1)
腹腔镜骶骨固定术	6(2.5)
腹腔镜髂耻韧带悬吊术	11(4.6)
腹腔镜侧腹壁悬吊术	28(11.8)
腹腔镜McCall后陷凹成形术	7(3.0)
联合腹腔镜子宫切除术	34(14.3)
阴道闭合术	45(19.0)
会阴体重建术	184(77.6)
抗尿失禁尿道中段悬吊带术	66(27.8)

表3 237例老年盆腔器官脱垂患者的手术方式

手术方式	例(%)
经阴道盆底重建术	122(51.5)
经阴道子宫切除术/腹腔镜或辅助经阴道子宫切除术	68(28.7)
经阴道骶棘韧带固定术	81(34.2)
经阴道自体组织前盆底重建修补术	72(30.4)
经阴道前盆底重建术(伴网片)	86(36.3)
经阴道自体组织阴道后壁修补术	152(64.1)
腹腔镜盆底重建术	70(29.5)
腹腔镜高位宫骶韧带悬吊术	31(13.1)
腹腔镜骶骨固定术	6(2.5)
腹腔镜髂耻韧带悬吊术	11(4.6)
腹腔镜侧腹壁悬吊术	28(11.8)
腹腔镜McCall后陷凹成形术	7(3.0)
联合腹腔镜子宫切除术	34(14.3)
阴道闭合术	45(19.0)
会阴体重建术	184(77.6)
抗尿失禁尿道中段悬吊带术	66(27.8)

表4 237例老年盆腔器官脱垂患者围手术期情况

观察项目	数值
手术时间[min, M(Q₁~Q₃)]	190(160~235)
术中出血量[ml,M(Q₁~Q₃)]	50(50~100)
输尿管膀胱损伤[例(%)]	0(0.0)
术后并发症[例(%)]	81(34.2)
术后新发血栓疾病[例(%)]	42(17.7)
下肢血栓[例(%)]	27(64.3)
下肢血栓合并肺栓塞[例(%)]	11(26.2)
肺栓塞[例(%)]	3(7.1)
心肌梗死合并下肢血栓[例(%)]	1(2.4)
术后尿潴留[例(%)]	43(18.1)
术后泌尿系感染[例(%)]	2(0.8)
术后出血及血肿[例(%)]	0(0.0)
术后转入SICU监护[例(%)]	39(16.5)
血红蛋白[术前-术后,g/L,M(Q₁~Q₃)]	15(7~23)
VTE评分[术后-术前,分,M(Q₁~Q₃)]	2(1~2)
术后住院时间[d,M(Q₁~Q₃)]	7(6~9)

表4 237例老年盆腔器官脱垂患者围手术期情况

观察项目	数值
手术时间[min, M(Q₁~Q₃)]	190(160~235)
术中出血量[ml,M(Q₁~Q₃)]	50(50~100)
输尿管膀胱损伤[例(%)]	0(0.0)
术后并发症[例(%)]	81(34.2)
术后新发血栓疾病[例(%)]	42(17.7)
下肢血栓[例(%)]	27(64.3)
下肢血栓合并肺栓塞[例(%)]	11(26.2)
肺栓塞[例(%)]	3(7.1)
心肌梗死合并下肢血栓[例(%)]	1(2.4)
术后尿潴留[例(%)]	43(18.1)
术后泌尿系感染[例(%)]	2(0.8)
术后出血及血肿[例(%)]	0(0.0)
术后转入SICU监护[例(%)]	39(16.5)
血红蛋白[术前-术后,g/L,M(Q₁~Q₃)]	15(7~23)
VTE评分[术后-术前,分,M(Q₁~Q₃)]	2(1~2)
术后住院时间[d,M(Q₁~Q₃)]	7(6~9)

表5 2组老年盆腔器官脱垂患者围手术期相关情况比较

观察项目	非MDT组(n=52)	MDT组(n=185)	Z/χ²值	P值
盆腔器官脱垂分期[例(%)]			11.959^a	0.003^d
Ⅱ期	7(13.5)	8(4.3)	4.279^b	0.039
Ⅲ期	30(57.7)	80(43.2)	3.407^b	0.065
Ⅳ期	15(28.8)	97(52.5)	9.060^b	0.003^d
手术方式[例(%)]			15.946^a	<0.001^d
经阴道盆底重建术	25(48.1)	97(52.4)	0.308^b	0.579
经腹腔镜盆底重建术	25(48.1)	45(24.3)	11.004^b	<0.001^d
阴道闭合术	2(3.8)	43(23.3)	9.928^b	0.002^d
手术时间[min, M(Q₁~Q₃)]	190(150~228.8)	190(160~237.5)	-0.680^c	0.497
术后转入SICU监护[例(%)]	2(3.8)	37(20.0)	7.705^a	0.006^d
血红蛋白[术前-术后,g/L,M(Q₁~Q₃)]	14(5.3~21.0)	17(8.5~24.0)	-1.320^c	0.187
VTE评分[术后-术前,分,M(Q₁~Q₃)]	2(1~2)	2(1~2)	-0.716^c	0.474
术后并发症[例(%)]	9(17.3)	72(38.9)	8.427^a	0.004^d
术后尿潴留[例(%)]	4(7.7)	39(21.1)	4.899^a	0.027^d
术后新发血栓疾病[例(%)]	5(9.6)	37(20.0)	3.002^a	0.083
术后住院时间[d,M(Q₁~Q₃)]	6(5~7)	7(6~9)	-4.022^c	<0.001^d

表5 2组老年盆腔器官脱垂患者围手术期相关情况比较

观察项目	非MDT组(n=52)	MDT组(n=185)	Z/χ²值	P值
盆腔器官脱垂分期[例(%)]			11.959^a	0.003^d
Ⅱ期	7(13.5)	8(4.3)	4.279^b	0.039
Ⅲ期	30(57.7)	80(43.2)	3.407^b	0.065
Ⅳ期	15(28.8)	97(52.5)	9.060^b	0.003^d
手术方式[例(%)]			15.946^a	<0.001^d
经阴道盆底重建术	25(48.1)	97(52.4)	0.308^b	0.579
经腹腔镜盆底重建术	25(48.1)	45(24.3)	11.004^b	<0.001^d
阴道闭合术	2(3.8)	43(23.3)	9.928^b	0.002^d
手术时间[min, M(Q₁~Q₃)]	190(150~228.8)	190(160~237.5)	-0.680^c	0.497
术后转入SICU监护[例(%)]	2(3.8)	37(20.0)	7.705^a	0.006^d
血红蛋白[术前-术后,g/L,M(Q₁~Q₃)]	14(5.3~21.0)	17(8.5~24.0)	-1.320^c	0.187
VTE评分[术后-术前,分,M(Q₁~Q₃)]	2(1~2)	2(1~2)	-0.716^c	0.474
术后并发症[例(%)]	9(17.3)	72(38.9)	8.427^a	0.004^d
术后尿潴留[例(%)]	4(7.7)	39(21.1)	4.899^a	0.027^d
术后新发血栓疾病[例(%)]	5(9.6)	37(20.0)	3.002^a	0.083
术后住院时间[d,M(Q₁~Q₃)]	6(5~7)	7(6~9)	-4.022^c	<0.001^d

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Analysis of the distribution of comorbidities in elderly female patients undergoing pelvic organ prolapse surgery and the effect of perioperative multidisciplinary team management

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Analysis of the distribution of comorbidities in elderly female patients undergoing pelvic organ prolapse surgery and the effect of perioperative multidisciplinary team management