宫颈癌根治性切除术后合并尿失禁的危险因素分析

Risk Factors of Urinary Incontinence after Radical Resection of Cervical Cancer

目的:探讨宫颈癌根治性切除术后合并尿失禁的影响因素,为其预防和个性化综合治疗提供依据。方法:回顾性分析2013年1月—2018年12月就诊于北京大学人民医院行宫颈癌根治性切除术后合并尿失禁的ⅠA1~ⅡA2期患者共14例(尿失禁组),另选取同期就诊接受宫颈癌根治性切除术治疗且未合并尿失禁的患者43例为对照组。记录患者一般资料及临床病理资料,对宫颈癌患者术后合并尿失禁的危险因素进行分析。结果:单因素分析显示,2组手术前后血红蛋白差值、淋巴结切除数目、手术时间、阴道断端长度和术者年手术量差异有统计学意义(均P<0.05)。多因素Logistic分析结果显示,手术前后血红蛋白差值大(OR=1.164,95%CI:1.006~1.348,P=0.042)、手术时间长(OR=79.896,95%CI:2.033~3139.492,P=0.019)、术者年手术量少(OR=13.116,95%CI:1.046~164.436,P=0.046)是患者术后发生尿失禁的独立危险因素。结论:对于合并手术前后血红蛋白差值大、手术时间长和术者年手术量少的宫颈癌患者,应及时采取有效的综合措施,预防术后尿失禁的发生。

Objective: To investigate the risk factors of postoperative urinary incontinence (UI) in patients with cervical cancer (CC) and provide evidence for prevention and individualized treatment of UI after radical resection of CC. Methods: This is a retrospective analysis of patients who had UI or no postoperative complications after radical resection of CC at Peking University People′s Hospital from January 2013 to December 2018. 14 patients with urinary incontinence in stage ⅠA1 to ⅡA2 after surgery were assigned to UI group and another 43 patients who were treated with radical CC resection at the same time without UI were selected as the control group. The general data and clinicopathological data were recorded and the risk factors of CC complicated with UI were analyzed. Results: Univariate analysis showed UI was closely related with difference in hemoglobin levels before and after surgery, number of resected lymph nodes, operative time, length of vaginal amputation and difference between annual surgery frequencies of surgeons (P<0.05). Multivariate Logistic analysis revealed that the high hemoglobin difference levels before and after surgery (OR=1.164, 95%CI: 1.006-1.348, P=0.042), longer operative time (OR=79.896, 95%CI: 2.033-3 139.492, P=0.019) and low annual surgery frequencies of the surgeon (OR=13.116, 95%CI: 1.046-164.436, P=0.046) were significantly associated with postoperative UI. Conclusions: For CC patients with high hemoglobin difference levels before and after surgery, longer operative time and low annual surgery frequencies of the surgeon, effective comprehensive measures should be taken in time to prevent UI.