子宫肌瘤患者全子宫切除术后性功能障碍的临床研究

Clinical study of sexual dysfunction after total hysterectomy in patients with uterine fibroid

目的:探讨影响子宫肌瘤患者全子宫切除术后性功能障碍的独立相关因素。方法:选取2013年1月至2016年5月在我院接受全子宫切除术治疗的155例子宫肌瘤患者作为研究对象。手术前后均采用性功能指数量表评估研究对象的性生活质量,先采用成组设计t检验或U检验对比研究对象不同临床特征分组之间的术后性功能指数量表评分,然后再采用多因素Logistic回归分析影响研究对象术后性功能指数量表评分的独立相关因素。结果:(1)与手术前相比,研究对象手术后性功能指数量表性反应、性体像、性态度、性满意度、性交流与调适、疼痛和情绪等6个维度评分均显著下降,手术前后相比差异均有统计学意义(P=0.000)。(2)研究对象年龄≥45岁组术后性功能指数量表评分显著低于年龄<45岁组(P=0.000),已婚组术后性功能指数量表评分显著高于其他婚姻状况组(P=0.000),配偶关系和谐组术后性功能指数量表评分显著高于不和谐组(P=0.000),宫颈保留组术后性功能指数量表评分显著高于宫颈未保留组(P=0.000)。研究对象体质指数≥25kg/m^2组与<25kg/m2组之间术后性功能指数量表评分比较差异无统计学意义(P=0.205),经腹手术组与经阴道手术组之间术后性功能指数量表评分比较差异无统计学意义(P=0.420)。(3)多因素Logistic回归分析显示,研究对象年龄是影响子宫肌瘤患者全子宫切除术后性功能障碍的独立危险因素(P=0.002),宫颈保留是独立保护因素(P=0.000),婚姻状况、配偶关系则是非独立相关因素(P=0.072、0.097)。结论:子宫肌瘤全子宫切除术患者应尽可能保留宫颈,这对改善患者术后性生活质量具有一定的临床意义。

Objectives： To investigate the independent related factors of sexual dysfunction after total hysterectomy in patients with uterine fibroid. Methods： 155 patients with uterine fibroid treated by hysterectomy in ourhospital from January 2013 to May 2016 were selected as research subjects. Before and after operation,functional index was used to assess the quality of sexual life. T test or u test was used to analyze postoperative sexual function index score of different groups with different clinical features. Multivariate Logistic regression was used to analyze the independent influence factors on function index scale. Results： The postoperative sexual function index scale reaction,body image,sexual attitudes,sexual satisfaction,sex communication and adjustment,pain and mood scores were significantly decreased,with significant differences（ P = 0. 000）. The sex function index scale score in age 45 years old group after operation were significantly lower than age 45 years old group（ P = 0. 000）. The postoperative sexual function index score of married group was significantly higher than that of other marital status group（P = 0. 000）. The postoperative sexual function index score in harmonious spouse relationship group was significantly higher than that of disharmony group（ P = 0. 000）. Postoperative sexual function index score of cervical preservation group was significantly higher than that of cervical not preserving group（ P = 0. 000）. The postoperative sexual function scale score in body mass index 25 Kg/m2 group and body mass index 25 Kg/m^2 group had no significant difference（ P = 0. 205）. The postoperative sexual function scale score in abdominal surgery group and vaginal surgery group had no significant difference（ P = 0. 420）. Multi Logistic regression analysis showed that the age was an independent risk factor of sexual dysfunction after hysterectomy in the treatment of uterus fibroid（ P = 0. 002）; cervical retention was an independent protective factor（ P = 0. 000）; marital status and spouse relationship were non-independent related factors（ P = 0. 072,0. 097）. Conclusion： It is of clinical significance to improve the postoperative quality of sex life of patients with uterine fibroid receiving total hysterectomy.