开腹和腹腔镜广泛子宫切除术对宫颈癌患者盆底功能及生活质量影响的比较

Pelvic floor dysfunction and QoL after laparoscopic versus abdominal radical hysterectomy in patients treated for cervical cancer

目的:比较腹腔镜与开腹两种不同手术路径对于宫颈癌患者广泛子宫切除术后盆底功能及生活质量的影响。方法:选取2012年7月~2017年8月因宫颈癌在北京大学人民医院进行广泛子宫切除术并有完整随访资料的150例患者,按手术路径分为经腹腔镜组(111例)和开腹组(39例)。采用盆底功能障碍问卷简表-20(PFDI-20)、膀胱过度活动症问卷(OABss)、欧洲五维健康指数量表(EQ-5D)对患者的盆底功能情况及生活质量进行评估。结果:患者中位随访时间为10.2个月。150例患者中术后压力性尿失禁66例(44%),膀胱过度活动症28例(18.7%),便秘、排便困难57例(38%)。腹腔镜和开腹手术组患者术后下尿路症状及排便症状的发生率比较,差异无统计学意义(P>0.05)。腹腔镜与开腹组患者术后的PFDI-20、OABss问卷得分比较,差异有统计学意义(P均<0.05),腹腔镜组患者存在更严重的脱垂、下尿路及排便症状(P均<0.05)。两组患者的EQ-5D量表得分比较,差异无统计学意义(P>0.05)。多因素分析发现,经腹腔镜手术是患者术后下尿路症状、膀胱过度活动症及排便功能障碍发生的主要危险因素。结论:广泛子宫切除术对宫颈癌患者盆底功能有严重影响,腹腔镜手术对于患者盆底功能的影响更大,对于早期宫颈癌患者也不主张选择腹腔镜手术方式。

Objective:To evaluate the pelvic floor symptoms and quality of life(QoL)after laparoscopic radical hysterectomy(LRH)or abdominal radical hysterectomy(ARH)for cervical cancer.Method:150 patients who underwent RH for treatment of cervical cancer in Peking University People's Hospital between July 2012 and August 2017 were enrolled.Patients were divided into two groups according to the surgical approach,including 111 underwent LRH and 39 underwent ARH.The validated versions of the Pelvic Floor Distress Inventory-short form 20(PFDI-20),the Over Active Bladder Symptom Score(OABss)and the Euro QoL Five Dimensions questionnaire(EQ-5D)system were used in detailed evaluation of postoperative lower urinary tract symptom(LUTS),anal distress and QoL.Results:The median follow-up time was 10.2 months.The incidence of postoperative stress urinary incontinence,overactive bladder and constipation was 44%,18.7%and 38%respectively.The incidence of pelvic floor symptoms showed no difference between two surgical approach group.There were significant differences in total score of PFDI-20 and OABss between LRH group and ARH group(P<0.05).Patients underwent LRH suffered from more severe symptoms of LUTS and anal distress.There was no significant difference in score of EQ-5D between two groups(P>0.05).Multiple analysis confirmed LRH was a risk factor for LUTS and OAB after adjusting other factors.LRH was also a risk factor for anal distress based on scores of CRADI-8.Conclusion:Compared with abdominal approach,laparoscopic approach for radical hysterectomy seems to increase the postoperative distress from LUTS and defecation symptoms.Therefore,laparoscopic surgery for cervical cancer should be carefully selected in clinical work.