广泛性子宫切除术联合盆腔淋巴结清扫术对宫颈癌患者盆底功能的影响

Effect of extensive hysterectomy combined with pelvic lymph node dissection on pelvic floor function in patients with cervical cancer

目的探究广泛性子宫切除术+盆腔淋巴结清扫术对宫颈癌患者盆底功能的影响。方法选取行广泛性子宫切除术+盆腔淋巴结清扫术的32例宫颈癌患者为宫颈癌组,选取同期行子宫全切术的32例子宫良性病变患者为对照组,对两组患者的术前和术后相关指标进行比较。结果手术前,两组患者尿失禁、尿潴留、排便困难、便失禁的发生率比较,差异均无统计学意义(P﹥0.05);手术后,宫颈癌组患者尿失禁、便失禁的发生率均高于对照组(P﹤0.05);手术后,两组患者尿潴留、排便困难的发生率比较,差异均无统计学意义(P﹥0.05);两组患者术后最大尿流率、平均尿流率、排尿时间、达峰时间比较,差异均无统计学意义(P﹥0.05);手术后,宫颈癌组患者的Ⅰ类肌纤维肌力、Ⅰ类肌纤维疲劳度、Ⅱ类肌纤维肌力、Ⅱ类肌纤维疲劳度、肌电位均低于对照组(P﹤0.05)。结论宫颈癌患者经广泛性子宫切除术+盆腔淋巴结清扫术后较易发生盆底功能障碍性疾病,长时间和大面积的手术可对患者的组织及神经造成严重损伤,影响患者的排尿、排便等盆底功能。

Objective To investigate the pelvic floor function of patients with cervical cancer after extensive hysterectomy combined with pelvic lymph node dissection. Method 32 patients with cervical cancer who underwent extensive hysterectomy ＋ pelvic lymph node dissection were included in the study as cervical cancer group, while another 32 patients with benign uterine disease who underwent hysterectomy during the same periodwere recruited as control. The preoperative and postoperative surgical measures were compared between the two groups. Result Before surgery, there was no significant differences in respect of the incidence of urinary incontinence, urinary retention, defecation disorder, and fecal incontinence between the two groups（P〈0.05）; after surgery, the incidence of urinary incontinence and fecal incontinence in patients with cervical cancer werehigher than that in the control group（P〈0.05）; after surgery, the incidence of urinary retention and defecation disorderwerenot statistically different between the two groups（P〈0.05）; the maximum urinary flow rate and mean urinary flow rate,urination time and time to peak urination after surgery were similar between the two groups（P〈0.05）; after surgery, the muscle strength and fatigue of type I and type II muscle fibers, as well as themyoelectric potential were lower in study group than those in the control group（P〈0.05）. Conclusion Cervical cancer patients are prone to develop pelvic floor dysfunction after extensive hysterectomy ＋ pelvic lymph node resection, of which the long operative time and largearea involvement can cause severe damage to the patient＇s tissues and nerves, affecting the patient＇s urination and defecation.