腹腔镜下保留盆腔自主神经广泛性子宫切除术对早期宫颈癌患者术后膀胱、直肠及性功能的影响

Effect of laparoscopic extensive pelvic autonomic hysterectomy on bladder,rectum and sexual function in patients with early cervical cancer

目的研究早期宫颈癌治疗中腹腔镜下保留盆腔自主神经广泛性子宫切除术(LNSRH)的应用效果及对患者术后膀胱、直肠及性功能的影响。方法采用回顾性分析方法,研究对象为2017年1月至2020年1月西北妇女儿童医院收治的68例早期宫颈癌患者。根据手术方式不同分为对照组和研究组,各34例。对照组选用腹腔镜下广泛性子宫切除术治疗,研究组选用LNSRH治疗。比较2组手术指标(术中出血量、手术时间、淋巴切除个数、住院时间)与术后膀胱功能指标(尿潴留率、尿失禁率、腹压排尿率、膀胱功能障碍率及保留导尿管时间)、直肠功能指标(排气时间、排便时间)、性功能评分(性交痛、性生活愉悦感、性活跃度、阴道功能)。结果研究组手术时间(260.57±56.82)min长于对照组(208.31±45.36)min,差异有统计意义(P<0.05);2组术中出血量、淋巴切除个数、住院时间比较,差异无统计学意义(P>0.05)。研究组术后尿潴留率、尿失禁率、腹压排尿率、膀胱功能障碍率分别为2.94%、0、5.88%、11.76%,低于对照组的23.53%、20.59%、26.47%、38.24%,保留导尿管时间(11.63±2.21)d短于对照组的(17.85±3.52)d,差异有统计意义(P<0.05)。研究组术后排气时间(56.58±8.81)min、排便时间(124.71±15.06)min,短于对照组[(80.06±8.67)min、(159.86±19.23)min],差异有统计意义(P<0.05)。研究组术后性交痛评分(1.81±0.72)分低于对照组(2.59±0.48)分,性生活愉悦感(2.38±0.61)分、性活跃度评分(2.01±0.53)分均高于对照组[(1.51±0.48)分、(1.62±0.61)分],差异有统计意义(P<0.05);2组术后阴道功能评分比较[(8.43±2.25)分vs.(8.57±2.31)分],差异无统计学意义(P>0.05)。结论早期宫颈癌治疗中LNSRH的应用效果优于腹腔镜下广泛性子宫切除术,可有效改善患者的膀胱、直肠及性功能。

Objective To investigate the efficacy and impacts on bladder,rectum and sexual function of patients treated with Laparoscopic preservation of pelvic autonomic nerve Broad-hysterectomy(LNSRH)in the treatment of early cervical cancer.Methods Retrospective analysis was conducted on 68 patients with early cervical cancer admitted from January 2017 to January 2020.According to different surgical methods,the subjects were divided into two groups,one group as the control group and the other group as the study group,with 34 patients in each group.The control group was treated with laparoscopic extensive hysterectomy,while the study group was treated with LNSRH.Compare two groups of operation indicators(intraoperative blood loss,operative time,number,length of hospital stay)lymph node excision and postoperative bladder function index(urinary retention rate,rate of urinary incontinence,abdominal pressure rate of urination and retention time of catheter,bladder dysfunction rate),rectum function index(exhaust time,defecation time),sexual function score(pain during sex,sexual pleasure,sexual activity,vaginal function).Results The operation time of the study group(260.57±56.82)min was longer than that of the control group(208.31±45.36)min,the difference was statistically significant(P<0.05).There was no difference in intraoperative blood loss,number of lymphectomy and length of hospital stay between the two groups(P>0.05).The rate of postoperative urinary retention,urinary incontinence,abdominal pressure voiding,and bladder dysfunction in the study group were 2.94%,0,5.88%,and 11.76%respectively,which were lower than those of the control group of 23.53%,20.59%,26.47%,and 38.24%,and the catheter retention time in the study group(11.63±2.21)d was shorter than that of the control group(17.85±3.52)d,the difference was statistically significant(P<0.05).The postoperative exhaust time(56.58±8.81)min,and the defecation time(124.71±15.06)min in the study group was shorter than the control group[(80.06±8.67)min,(159.86±19.23)min],the difference was statistically significant(P<0.05).The postoperative pain score of the study group(1.81±0.72)points was lower than that of the control group(2.59±0.48)points,and the scores of sexual pleasure(2.38±0.61)points and sexual activity(2.01±0.53)points were higher than those of the control group[(1.51±0.48)points,(1.62±0.61)points],the differences were statistically significant(P<0.05).Comparison of postoperative vaginal function scores between the two groups[(8.43±2.25)points vs.(8.57±2.31)points],the difference was not statistically significant(P>0.05).Conclusion LNSRH is more effective than laparoscopic extensive hysterectomy in the treatment of early cervical cancer,and can effectively improve the bladder,rectum and sexual function of patients.