腹膜阴道延长术加心理干预对早期宫颈癌患者性生活及生命质量的影响

Impact of vaginal lengthening of peritoneum and psychological intervention on sexual life and quality of life in patients with early cervical cancer

目的:评估腹膜阴道延长术及心理干预对早期宫颈癌患者性生活质量及生活质量的影响。方法:选择2012年6月年至2014年6月的早期宫颈癌患者40例作为研究组,实施开腹广泛子宫切除术加腹膜阴道延长术加盆腔淋巴结清扫术,辅以心理干预。选择在同期住院的宫颈癌患者30例实施广泛子宫切除术加盆腔淋巴结清扫术作为对照组。术后对性生活相关指标进行比较,并采用性生活和阴道变化(SVQ)问卷及Olson婚姻质量问卷对患者性生活状态及生命质量进行评估,评价阴道延长及心理干预对早期宫颈癌患者性生活及生命质量的影响。结果:研究组与对照组在阴道长度、术后恢复规律性生活的时间、影响性生活的因素方面比较,差异有显著性(P<0.05),而术后并发症等方面差异无显著性(P>0.05)。术后SVQ问卷提示两组患者均存在阴道润滑度降低、性交痛。而在自觉阴道太小而性交不适、因无性生活而不满意、从未或很少在性生活后感到放松、性伴侣低性欲或无性欲、亲密度、对自我形象不满意等方面,两者比较,差异有显著性(P<0.05)。Olson婚姻质量问卷中夫妻交流、性生活、角色平等、婚姻满意度4方面研究组与对照组比较,差异有显著性(P<0.05)。结论:对早期宫颈癌患者实施阴道延长术,可延长患者阴道长度,加用心理干预,可明显改善患者的性生活质量。临床医师在宫颈癌治疗的过程中,应为患者实施阴道延长,并重视患者性生活的指导及心理状态的干预。

Objectives： To evaluate the effect of vaginal lengthening of peritoneum and of psychological intervention on sexual life and quality of life for patients with the early cervical cancer. Methods： 40 patients of early -stage （Ibl -Ib2） cervical cancer were included in study group, who underwent vaginal extension following class radical hysterectomy （RH） and pelvic lymphadenecomy, and psychological intervention as well, while 30 patients with radical hysterectomy and pelvic lymphadeneeomy only during the same period were allocated as control group. Case -control and Questionnaire -based method was employed in this study. Patients were assessed retrospectively by Sexual Function and Vaginal changes Questionnaire （SVQ） and Oslon＇ s marriage quality questionnaire mainly for quality of sexual life and sexual function as well as quality life at least 6 months after treatment. The key performance indicators of postoperative sexual life were analyzed and compared as well. Results： Postoperative vaginal length acquired by pelvic examination genecologic oncologists was （ 9.65 ±0. 64） cm an （4.99 ±0. 86 ） cm in the study group and the control group respectively （P 〈 0. 05 ）. 92.3% （36/39） of the cases in the study group and 63.3% （19/30） in the control group had resumed sexual activity, and the mean time interval between treatment and regular sexual activity was 6 months （range 2 -6 months） and mean 6 months （range 4 - 16 months） in the study group and the control group respectively. Factors affecting sexual life were reduced in the study group, in which there was of significant difference, while there was no significant difference in postoperative complications between the study group and control group. Both groups presented with vaginal lubrication and painful sex. While the reduced vagina size and shorter vagina, low enjoyment or relaxation after sex, diminished sexual desire of sex partner, family cohesion, self- image satisfaction in the study group were more prominent than the control group with statistical significance （P 〈 0.05 ）. There was significant difference in that of the intercommunion of the couple, sexual life, equal role, satisfaction of marriage between the two groups （P 〈 0. 05 ） from the Oslon＇ marriage quality questionnaire. Conclusion： Early stage cervical cancer patients with vaginal lengthening, prolongs the vagina length, and combined with psychological intervention can significantly improve the quality of sexual life and psychological status of patients. In the course of treatment for cervical cancer, it is recommended that vaginal extension following RH should be performed with the guide of sexual life and psychological intervention.