腹腔镜下保留盆腔自主神经的广泛性子宫切除术对Ib_1期育龄期宫颈癌患者术后肛门直肠功能和性功能的影响

Effect of Laparoscopic Nerve-sparing Radical Hysterectomy on Anorectal Function and Sexual Function of Reproductive Patients with Ib_1 Cervical Cancer

目的探讨腹腔镜下保留盆腔自主神经的广泛性子宫切除术(LNSRH)对Ib_1期育龄期宫颈癌患者术后肛门直肠功能和性功能的影响。方法入组100例Ib_1期育龄期宫颈癌患者,用信封法随机均分为2组,分别接受LNSRH手术加盆腔淋巴结清扫术(LPL,观察组)和腹腔镜下广泛性子宫切除术(LRH)加LPL(对照组),并比较观察2组患者的肛门直肠功能和性功能变化。结果术后1 a时,观察组便秘、腹泻发生率低于对照组(P<0.05),2组排便不尽感发生率比较差异无统计学意义(P>0.0.05);排便功能自我评价结果显示,2组排便功能自我评价结果构成比比较差异有统计学意义(P>0.05),观察组自我评价更好。2组肛管最大缩榨压、初始感觉阈值、初始排便阈值比较差异有统计学意义(P<0.05),而其他肛管直肠测压参数比较差异均无统计学意义(P>0.05)。2组患者术后1 a性欲望、性唤起、阴道润滑度、性高潮、性生活满意度、总评分比较差异均有统计学意义(P<0.05),而性交疼痛比较差异无统计学意义(P>0.05);观察组性功能障碍发生率为42.00%,明显低于对照组的80.00%(P<0.05)。结论 LNSRH用于治疗Ib_1期育龄期宫颈癌患者,比LRP能够更好改善患者的肛门直肠功能和性功能,提高患者的生活质量和性生活状态。

Objective To investigate the effect of laparoscopic nerve-sparing radical hysterectomy （LNSRH） on anorectal function and sexual function of reproductive patients with Ib1 cervical cancer. Methods 100 reproductive patients with Ib1 cervical cancer were randomized by envelope technique to the observation group （50 patients） or the control group （50 patients）, and the anorectal function and sexual function were compared between the two groups. Results In the 1 year after surgery, the constipation and diarrhea incidences in the observation group were lower than those in the control group （ P 〈 0.05 ）. There was no statistically significant difference in the endless defecate feeling incidence between the two groups （ P 〉 0.05 ）. The defecation function of self assessment in the observation group was better than that in the control group（ P 〈 0.05 ）. There were statistically significant differences in the maximal anal squeeze pressure, initial sensory threshold and initial exclusion threshold between the two groups （ P 〈 0.05 ）. There were statistically significant differences in the score of sexual desire, sexual arouse, vaginal lubrication, orgasm, sexual satisfaction orgasm and total score in the observation group was higher than those of the control group, but there was no statistically significant difference in the score of dyspareunia between the two group. The incidence of sexual dysfunction in the observation group （42.00%） was significantly lower than that in the control group （80.00%, P 〈 0.05 ）. Conclusion For the reproductive patients with Ib1 stage cervical cancer, LNSRH can improve the anorectal function and sexual function, improve the patient＇ s quality of life and sex status.