输尿管肾镜术后放置JJ管对女性性功能指数的影响

The effect of the placement of JJ stenting after ureterorenoscopyon female sexual function index

目的目前,影响女性性功能的各种病因已经被广泛研究,但是输尿管肾镜手术对女性性功能障碍的影响尚不清楚。本研究旨在探讨输尿管肾镜术后留置JJ管对女性性功能的影响。方法采用前瞻性研究,前瞻性选取2014年9月至2017年11月苏州大学附属第一医院和盐城市中医院诊治的年龄大于22岁有规律性生活的确诊输尿管结石的已婚中青年女性患者67例作为研究对象。根据患者结石负荷、是否为孤立肾、术中输尿管损伤或输尿管梗阻严重影响肾功能等情况选择是否术后放置JJ管。67例患者分为两组:研究组35例,行输尿管镜碎石术与JJ管置入术;对照组32例,行输尿管镜取石术术后不留置JJ管。术前、术后第一个月和第三个月使用女性性功能指数(female sexual function index,FSFI)评估性功能。记录和评估患者的总体满意度、年龄、手术时间、支架留置时间、体重指数(body mass index,BMI)、结石负荷、月收入状况、受教育程度和心理状态等临床资料。结果两组患者年龄、BMI、住院时间、月收入状况和受教育程度比较,其差异均无统计学意义(均P>0.05);两组患者结石负荷比较,差异具有统计学意义(P<0.05)。研究组和对照组术前FSFI总评分分别为(22.2±0.86)、(24±0.71);术后第一月FSFI总评分分别为(13±0.71)、(23.4±0.98);术后第三月FSFI总评分分别为(22.6±0.81)、(22.2±1.32)。术前和术后第三个月FSFI总评分,两组间比较差异无统计学意义(P>0.05);术后第一月FSFI总评分,两组间比较差异有统计学意义(P<0.05)。在术后第一月FSFI 6个具体领域方面,研究组的主观性唤起能力、性高潮和性生活满意度下降,性交痛增加,这四个领域与对照组分别比较,差异具有统计学意义(P<0.05);在性欲、性活动时阴道润滑度两个领域,两组间比较差异无统计学意义(P>0.05)。研究组术前、术后第一月、术后第三月的性功能障碍发生率分别为34.29%、85.71%、37.14%;对照组分别为31.25%、37.5%、34.38%。研究组在术后第一个月性功能障碍发生率显著升高,与对照组分别比较,差异有统计学意义(P<0.05);术前和术后第三个月,两组间比较差异无统计学意义(P>0.05)。研究组术前、术后第一个月和第三个月的Beck抑郁自评量表(beck depression inventory,BDI)评分分别为(6.2±1.4)、(4.5±1.6)、(5.2±1.1);对照组分别为(5.5±1.7)、(5.1±1.7)、(5.3±0.9),两组间比较差异均无统计学意义(均P>0.05)。结论输尿管肾镜(包含硬镜、软镜、PNL)术后留置JJ管对女性性功能会产生相当大的负面影响。虽然性功能的下降是暂时性的,通常会在输尿管镜手术后第三个月恢复,因此,应当尽量避免放置JJ管或缩短JJ管留置的时间。如果病情必须放置JJ管,那么术前应该告知患者在术后第一个月有一定程度的性功能障碍,通常会在术后三个月左右恢复,并且要尽可能缩短JJ管放置的时间。

Objective Toinvestigate the effect of the placement of JJ stenting after ureterorenoscopy on female sexual function index.Methods This was a multicenter prospective study.The clinical data of 67married patients with ureteral stoneover 22 years old in the First Affiliated Hospital of Soochow University and Yancheng Hospital of Traditional Chinese Medicinefrom September 2014 to November 2017 were collected and analyzed.According to the patient's stone burden,the presence of a solitary kidney,ureteral injury,serious ureteral obstruction or renal insufficiency,the 67 patients were divided into study group(n=35)and control group(n=32).Patients in the study group underwent ureterorenoscopy with JJ stenting placement and patients in the control group underwent ureterorenoscopy without JJ stenting placement.Female Sexual Function Index(FSFI)was used to evaluate the sexual function of patients before and a month and 3 months after operation.The total satisfaction,age,operative time,stent indwelling time,Body Mass Index(BMI),stone burden,monthly income,education level and psychological status were recorded and evaluated.Results There was no statistically significant differences in age,BMI,time of hospitalization,monthly income and education level between the two groups(all P>0.05).The stone burden was significantly higher in study group than the control group with statistically significant difference(P<0.05).The mean FSFI scorespreoperative were(22.2±0.86)and(24±0.71),the mean FSFI scores a month postoperativewere(13±0.71)and(23.4±0.93),and the mean FSFI scores 3 months postoperative were(22.6±0.81)and(22.2±1.32)in the study group and control group respectively.There was no statistically significant difference between the two groups at preoperative and 3 months postoperative(P>0.05),while the difference at a month postoperative was statistically significant(P<0.05).At a month postoperative,the sexual arousal,orgasm,and satisfaction statistically decreased and intercourse pain increased in the study group compared to these in control group,with statistically significant differences(P<0.05),while no significant difference was found in sexual desire and vaginal lubricationbetween the two groups(P>0.05).The incidence of sexual dysfunction was 34.29%,85.71%and 37.14%in the study group and 31.25%,37.5%and 34.38%in the control group at preoperative and a month and 3 months postoperative,with statistically significant difference at a month postoperative(P<0.05)and no significant differences at preoperative and 3 months postoperative between the two groups(P>0.05).The mean Beck depression scores at preoperative,a month and 3months postoperative were(6.2±1.4),(4.5±1.6)and(5.2±1.1)in the study group and(5.5±1.7),(5.1±1.7)and(5.3±0.9)in control group,without statistically significant differences between groups(P>0.05).Conclusions The placement of JJ stenting afterureterorenoscopy(including rigid ureterorenoscopy,flexible ureteroscopy and percutaneous nephrolithotomy)has considerably negative effects on female sexual function though the deterioration of sexual function is temporary and generallyreturns within 3 months postoperative.Therefore,the placement of JJ stenting should be avoided and the duration should be shortenedif the placement is inevitable.