妇科手术对女性排尿情况的影响分析

Analysis in Gynecological Surgeries Affected Urinary Function

【目的】通过测定妇科手术患者尿流率参数了解妇科手术对患者排尿功能的影响。【方法】随机选择2010年3月至2011年3月在我院行妇科手术,无其他合并症及并发症的100例女性患者作为研究对象,除外合并泌尿系感染及器质性疾病者。包括开腹子宫切除术组(27例),阴式子宫切除术组(28例),广泛性子宫切除加盆腔淋巴结清扫组(24例),腹腔镜附件手术组(21例)测定最大尿流率(Qmax)、平均尿流率(AFR)、排尿量(VV)、尿流时间(FT)等。应用B超测量膀胱三条径线:a、b、c,以a×b×c×0.7 mL估算残余尿量(PVR)。【结果】腹腔镜附件手术组和开腹子宫切除术组手术前后的Qmax、AFR、FT、VV、PVR,差异均无统计学意义(P>0.05),手术前后最大尿流率均在正常范围。阴式子宫切除和广泛性子宫切除加盆腔淋巴结清扫术组的Qmax、AFR、VV、PVR手术前后差异有统计学意义(P<0.05),术后Qmax、AFR、VV明显低于术前,术后PVR明显高于术前。【结论】阴式子宫切除术和广泛性子宫切除加盆腔淋巴结清扫等手术使患者的膀胱产生了明显的功能障碍,特别是广泛性子宫切除加盆腔淋巴结清扫手术对患者膀胱的影响是严重的和深远的,这种影响的产生可能与手术中的神经损伤、膀胱创伤等有关,今后在两类手术中如何最大限度减小手术对排尿功能的影响是未来手术改进的方向之一。

[ Objective ] To determine whether gynecological surgeries affected urinary function, this study prospectively examined uroflowmetry parameters in the patients underwent gynecological surgery. [ Methods ] Subjects （n =100） were selected randomly from a list of gynecological surgery. They were divided into 4 groups based on type of surgeries ： group I had open hysterectomy （n = 27） ; group II had transvaginal hysterectomy （n=28）;group Ⅲ had extensive abdominal hysterectomy and bilateral pelvic lymphadenectomys （n =24）; and group IV had adnexectomy with laparoscopy （n =21 ）. Uroflowmetry parameters, such as maximum flow rate （Qmax）, average flow rate, flow time, voided volume, and residual rate were measured during preoperation and postoperation. Ultrasound post void residual （PVR） urine volumes were obtained before and after surgery. [ Result] Uroflowmetry parameters showed no significant change （P 〉 0.05） in open hysterectomy and adnexectomy with A laparoscope groups. The Qmax was in normal rage during preoperation and postoperation. Uroflowmetry parameters had significant difference before and after surgery （P 〈 0.05） in extensive abdominal hysterectomy with bilateral pelvic lymphadenectomyand and transvaginal hysterectomy groups was very marked. Qmax, AFR, and VV were significantly lower in postoperative than in preoperative and PVR was significantly higher in postoperative period than those in preoperative period. [Conclusion] The subject who underwent extensive abdominal hysterectomy with bilateral pelvic lymphadenectomy and transvaginal surgeries had voiding disfunction. Although the reason for this higher rate is unclear, it may be related to injury of bladder and nerve. Therefore it is important to improve skills in above two kinds of surgery procedures which will minimum the injury in urinary bladder function.