子宮傾度與經痛及經前症候群之相關性探討

The association of uterine version angle with dysmenorrhea and premenstrual syndrome

劉仁杰(Jen-Chieh Liu)

指導教授 ： 林隆堯

中山醫學大學/醫學院/醫學研究所/碩士(2007年)

https://doi.org/10.6834/CSMU.2007.00045

摘要

研究目的：探討先天性後傾子宮(retroverted uterus)者，其經痛(dysmenorrhea)和經前症候群(premenstrual syndrome)的嚴重度與前傾子宮(anteverted uterus)者比較是否有差異。並進一步分別分析後傾子宮(retroverted utrus)和前傾子宮(anteverted uterus)兩組人之經痛(dysmenorrhea)及經前症候群(premenstrual syndrome)嚴重度與子宮傾度間是否有角度上的相關。

材料與方法：以院內之18-20歲未婚、未生產過之護理人員及護理實習生，再排除曾開過任何腹部手術、曾有任何已知的子宮卵巢異常不管治療或未治療過、骨盆腔超音波檢查有任何子宮卵巢異常者。
以視覺類比量表Visual Analogue Scale (VAS)評估dysmenorrhea的嚴重度，再以牟氏問卷 Moos Menstrual Distress Questionnaire(Moos MDQ)評估premenstrual syndrome的情況。並以腹部超音波量取陰道連線與子宮腔連線之夾角，稱之為子宮傾度(uterine version angle)。將所得資料分析retroverted和anteverted兩組各自在所有個案中所佔的比例；比較retroverted和anteverted兩組間關於Age、Height、Weight、BMI、Menarche age、dysmenorrhea VAS及PMS Moos MDQ scale是否有差異；以回歸分析dysmenorrhea VAS及PMS Moos MDQ scale各自在retroverted與anteverted兩組中和uterine version angle間是否有相關。

研究結果：在最後進入本研究的128位個案中，有28位是後傾的(retroverted) ( 21.9% ) 而有100位是前傾的(anteverted) ( 78.1% )；也就是說在本研究之先天性後傾子宮(retroverted uterus)的prevalence約為22％。關於dysmenorrhea VAS方面，retroverted group是6.60 ±2.063而anteverted group是3.60 ±2.584，P<0.001，顯示後傾子宮組的經痛情形確實比前傾子宮組明顯嚴重。而dysmenorrhea VAS分別在retroverted group及anteverted group中與子宮傾度( uterine version angle )的廻歸分析中都沒有明顯的角度相關。關於PMS Moos MDQ scale方面，retroverted group是101.89 ±33.954而anteverted group是87.70 ±27.790， P<0.05，顯示後傾子宮組的經前症候群情形也比前傾子宮組嚴重。而PMS Moos MDQ scale分別在retroverted group及anteverted group中與子宮傾度( uterine version angle ) 的廻歸分析中也都沒有明顯的角度相關。

討論：後傾子宮(retroverted uterus)在一般婦女所佔比例的統計，由於各個研究所使用的方法工具和對象條件不同，有些是以骨盆腔檢查( bimanual pelvic examination)，有些是以腹部超音波( transabdominal ultrasound )，有些是以陰道超音波( transvaginal ultrasound )，甚至有用核磁共振( magnetic
resonance imaging ；MRI )，各個研究的數據差異性還滿大的，從10％到38％都有。本研究個案以年輕( 18-20歲)、未婚、未生產、未曾開過任何腹部手術、未曾有已知的子宮卵巢異常(不管治療或未治療過)、且在本研究之超音波檢查無任何之異常發現者，主要的目的就是在排除任何後天因素可能造成子宮位置的改變，如此才能更忠實地呈現先天性之後傾子宮(retroverted uterus)在一般婦女所佔的比例(prevalence)，也才能更精確地探討先天性之後傾子宮(retroverted uterus)與各種婦產科有關疾病或症狀的相關性。
Fauconnier A.等人曾以骨盆腔檢查( bimanual pelvic examination )的方法，排除子宮固定不動(fixed uterus)的個案，探討經痛(dysmenorhea)及性交疼痛(dyspareunia)在後傾子宮(retroverted uterus)與前傾子宮(anteverted uterus)的相關性，結果發現後傾子宮(retroverted uterus)組經痛(dysmenorhea)及性交疼痛(dyspareunia)的盛行率(prevalence)都比前傾子宮
(anteverted uterus)組高〔經痛(dysmenorhea)( 66.7％ versus 42.9％, p=0.03 )及性交疼痛(dyspareunia)( 66.7％ versus 42.1％, p=0.03)〕。

結論：在儘可能排除因後天因素所造成的後傾子宮(retroverted uterus)情況下，先天性之後傾子宮(retroverted uterus) 者在本研究中的prevalence約22％(21.9％)。後傾子宮組的經痛(dysmenorhea)和經前症候群(premenstrual syndrome)在本研究中確實都比前傾子宮組嚴重。但不論在後傾子宮組或前傾子宮組，經痛( dysmenorhea)和經前症候群( premenstrual syndrome)與子宮傾度(uterine version angle)間並沒有明顯的角度相關性，也就是說沒有子宮傾度(uterine version angle)角度越大而經痛(dysmenorhea)和經前症候群(premenstrual syndrome)的情形就越嚴重的相關性。

關鍵字

經痛 ； 經前症候群 ； 子宮傾度

並列摘要

Obsjective： To compare the retroverted uterus group with the antevered uterus group , if there are differences to the dysmenorrhea and the premenstrual syndrome severity. And further analyse if there are the correlation between the uterine version angle and dysmenorrhea or premenstrual syndrome severity .

Materials and metholds： We collect one hundred and thirty nine 18-20 years old unmarried , no delivery history nurse or nursing student in our hospital , then exclude ever received any abdominal operation or ever had any uterine or ovarian abnormality regardless with or without treatment or had any uterine or ovarian abnormality during this study ultrasonography exam. Use the Visual Analogue Scale (VAS) to evaluate dysmenorrhea severity and use the Moos Menstrual Distress Questionnaire(Moos MDQ) to evaluate the premenstrual syndrome condition , and performed trans-abdominal ultrasonography to measure the angle between the vaginal line and the uterine cavity line ( uterine version angle ). Then analyse the prevalence of retroverted uterus women , and compare the retroverted uterus group with the antevered uterus group , if there are differences to the dysmenorrhea and the premenstrual syndrome severity , and the correlation between the uterine version angle and dysmenorrhea VAS or premenstrual syndrome MDQ scale .

Results： There are one hundred and twenty eight women into the study finally , twenty eight women are retroverted ( 21.9% ) and one hundred are anteverted ( 78.1% )；so the prevalence of congenital retroverted uterus is about 22％. The dysmenorrhea VAS of the retroverted group is 6.60 ±2.063 and the anteverted group is 3.60 ±2.584 , P<0.001； the PMS Moos MDQ scale of the retroverted group is 101.89 ±33.954 and the anteverted group is 87.70 ±27.790 , P<0.05 . But there are no obvious correlation between the uterine version angle and dysmenorrheal VAS or premenstrual syndrome MDQ scale by the liner regression analysis .

Discussion： For the reason of different of study tool or study member condition , there are different results about the prevalence of retroverted uterus women ( from 10％ to 38％) Our study focus at young (18-20 years old) , unmarried , no delivery history nurse or nursing student in our hospital , and exclude ever received any abdominal operation or ever had any uterine or ovarian abnormality regardless with or without treatment or had any uterine or ovarian abnormality during this study ultrasonography exam. The purpose is to find out the prevalence of congenital retroverted uterus to the best of our ability , thus we can more accurately to discussing the relationship between dysmenrrhea and premenstrual syndrome with the congenital retroverted uterus women .

Conclusion： The prevalence of congenital retroverted uterus is about 22％ in our study . Retroverted group women have much severity of dysmenorhea and premenstrual syndrome compare with anteverted group women in this study . And whether the retroverted group or the anteverted group , there are no obvious correlation between the uterine version angle and dysmenorrhea or premenstrual syndrome severity .

並列關鍵字

Dysmenorrhea ； Premenstrual syndrome ； Uterine version angle

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