婦人科がんの手術治療後の生活の質と尿失禁の有病率：アンケート調査

Quality of life and the prevalence of urinary incontinence after surgical treatment for gynecologic cancer: a questionnaire survey.

• Noriko Nakayama
• Tetsuya Tsuji
• Makoto Aoyama
• Takafumi Fujino
• Meigen Liu

抄録

背景:

婦人科がんの手術介入に伴う排尿症状や排尿後の症状に関する報告は多いが、尿失禁（UI）や過活動膀胱（OAB）などの蓄尿症状に関する報告は少ない。本研究の目的は、婦人科がん手術後の蓄尿症状の発生率とQOL（Quality of Life）への影響を検討することであった。

BACKGROUND: Although there have been a number of reports on urinary voiding symptoms associated with surgical interventions for gynecologic cancer and post-voiding symptoms, there have been few reports on urinary storage symptoms such as urinary incontinence (UI) and overactive bladder (OAB). The purpose of this study was to examine the rates and impact on quality of life (QOL) of urinary storage symptoms after gynecologic cancer surgery.

方法:

2008年から2013年の間に子宮摘出術を受けた婦人科がん患者を対象に、International Consultation on Incontinence Questionnaire-Short Form（ICIQ-SF）、Overactive Bladder Symptom Score（OABSS）、Incontinence Impact Questionnaire-7（IIQ-7）の日本語版を含む質問紙調査を実施した。

METHODS: A questionnaire survey, including Japanese-language versions of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Overactive Bladder Symptom Score (OABSS), and Incontinence Impact Questionnaire-7 (IIQ-7), was distributed to gynecologic cancer patients who underwent hysterectomy between 2008 and 2013.

結果:

解析した145例のうち、術前にUIを有していたのは49例（33.8％）、術後にUIを有していたのは76例（52.4％）で、そのうち34例（35.4％）は初めてUIを受けた患者であり、術前と術後では有意な差があった。術前UI患者49例中、43例（87.7％）にストレス性尿失禁があり、術後UI患者76例中、44例（57.1％）にストレス性尿失禁があり、24例（31.2％）に混合性尿失禁があった。術前にOABがあったのは7人（4.8％）であったのに対し、術後にOAB症状があったのは19人（13.1％）であり（初診のOAB患者15人を含む）、術前と術後では有意な差があった。IIQ-7スコアは、術後に混合性失禁を呈した患者の方がストレス性失禁を呈した患者よりも明らかに高く、QOLの低下を示していた。ロジスティック回帰分析により、術後尿失禁の危険因子として、帝王切開数と膀胱カテーテル留置日数が同定された。

RESULTS: Of the 145 patients analyzed, 49 (33.8%) had UI pre-surgery, and 76 (52.4%) had UI post-surgery, including 34 (35.4%) first-time UI patients, with a significant difference between pre- and post-surgery. Of the 49 subjects with UI pre-surgery, 43 (87.7%) had stress incontinence, while of the 76 patients with UI post-surgery, 44 (57.1%) had stress incontinence, and 24 (31.2%) had mixed incontinence. Seven (4.8%) subjects had OAB pre-surgery, whereas 19 (13.1%) had OAB symptoms post-surgery (including 15 first-time OAB patients), with a significant difference between pre- and post-surgery. IIQ-7 scores were markedly higher for patients with mixed incontinence post-surgery than for those with stress incontinence, indicating a lower QOL. Logistic regression analysis identified the number of Cesarean sections and days of urinary bladder catheterization as risk factors for postoperative UI.

結論:

婦人科がん手術後の UI および OAB 率は、一般女性集団よりも高かった。手術後の混合性失禁率は著しく高く、このような患者では切迫性とストレス性の失禁が混在しているため、QOLは低かった。複数回の帝王切開と術後の膀胱カテーテル検査は術後の尿失禁の危険因子であった。

CONCLUSIONS: UI and OAB rates were higher after gynecologic cancer surgery than in the general female population. The mixed incontinence rate was markedly higher post-surgery; QOL was low for such patients due to the combination of urge and stress incontinence. Multiple Cesarean sections and urinary bladder catheterization post-surgery were risk factors for post-surgical UI.