腹腔镜下全子宫加双附件切除术对Ⅰ期子宫内膜癌患者预后的影响分析

Effect of laparoscopic hysterectomy on the prognosis in patients with stage I endometrial cancer

目的探讨腹腔镜下全子宫加双附件切除术对Ⅰ期子宫内膜癌的治疗效果及对预后的影响。方法选取2017年1月至2017年5月间北京市平谷区医院收治的30例Ⅰ期子宫内膜癌患者,分析经全子宫加双附件切除术后患者的生活质量,多因素分析患者预后的影响因素。结果术后6个月,患者生活质量提高,负面情绪降低;但FSFI总分及性欲望、性呼唤及性高潮等单项评分均低于术前,差异均有统计学意义(均P<0.05)。单因素分析结果显示,患者年龄、病理分期、病理分级、有复发高危因素、治疗前卵巢癌的特异性标志物(CA-125)及术后心理干预为Ⅰ期子宫内膜癌的预后影响因素。以术后预后不良为因变量(术后复发为1,未复发为0),行Cox风险比例模型分析。结果显示,患者年龄、病理分级、有复发高危因素及病理分期为Ⅰ期子宫内膜癌患者预后不良的危险因素。术后心理干预为Ⅰ期子宫内膜癌患者预后不良的保护因素,差异均有统计学意义(均P<0.05)。结论Ⅰ期子宫内膜癌患者行全子宫加双附件切除术后,短期内患者负性情绪及生活质量得到改善,性生活质量下降,术后辅助治疗及心理干预有助于提高生存质量。

Objective To observe the effect of laparoscopic hysterectomy on the prognosis in patients with stage I endometrial cancer.Methods Thirty patients with stage I endometrial cancer treated at Pinggu District Hospital from January 2017 to May 2017 were selected.Postoperative quality of life was evaluated.The factors influencing the prognosis were analyzed by a multivariate analysis.Results At six months after the operation,quality of life was improved and the negative emotion was decreased.However,the overall score of sexual desire,sexual appeal and orgasm decreased(all P<0.05).Univariate analysis revealed that age,pathological staging,pathological grade,high risk factors for recurrence,preoperative biomarker CA-125 and postoperative psychological intervention were factors influencing the prognosis of endometrial cancer.Poor postoperative prognosis was considered as a dependent variable(recurrence rate 1,recurrence rate 0),and Cox proportional hazard model was used to analyze the prognosis.The results showed that age,pathological grade,high risk factors for recurrence and pathological stage I were the risk factors for poor prognosis of stage I endometrial cancer(all P<0.05).Postoperative psychological intervention was the protective factor for poor prognosis of stage I endometrial cancer.Conclusion The short-term negative emotions and quality of life were improved after total hysterectomy in patients with stage I endometrial cancer,but the quality of sexual life was decreased.Postoperative adjuvant therapy and psychological intervention were helpful to improve the quality of life.