子宫颈癌根治性子宫切除术后下尿路症状及相关因素分析

Analysis of lower urinary tract symptoms and related factors following radical hysterectomy for cervical cancer

目的了解子宫颈癌根治性子宫切除术后患者下尿路症状患病情况及其相关因素。方法选择2012年1月至2015年3月在全国13家研究中心接受PiverⅢ型子宫切除的690例宫颈癌患者,并按照年龄和体质指数匹配妇科门诊无手术史良性疾病患者690例作为对照组,采用女性下尿路症状国际尿失禁标准问卷(ICIQFLUTS)和膀胱过度活动症评分(overactive bladder symptom score,OABSS)对两组患者进行问卷调查。结果宫颈癌组下尿路症状患病率(78.3%,540/690)与对照组(78.7%,543/690)相似(P>0.05)。宫颈癌组储尿期症状患病率(66.2%,457/690)低于对照组(75.5%,521/690)(P<0.05),而排尿期症状(52.3%,361/690)和膀胱过度活动症(overactive bladder symptom,OAB)(14.5%,100/690)患病率显著高于对照组(24.1%,166/690;8.8%,61/690)(P<0.05)。单因素分析显示,腹腔镜手术、术中切除宫旁长度或阴道长度>3 cm与排尿期症状、OAB患病相关(P<0.05)。Logistic分析显示,腹腔镜手术是排尿期症状(OR=2.380,95%CI:1.664~3.405)和OAB的危险因素(OR=1.972,95%CI:1.155~3.367)。结论宫颈癌患者根治性子宫切除术后排尿期症状及OAB患病率升高,可能与切除较多的宫旁和阴道组织有关。

Objective To investigate the morbidity of lower urinary tract symptoms(LUTS) in patients after Piver Ⅲ radical hysterectomy(RH Ⅲ)for cervical cancer and analyze associated factors. Methods From January 2012 to March 2015, 690 patients who received RH Ⅲ in 13 hospitals were selected, and 690 patients with benign gynecological diseases(no surgical history) were matched according to age and BMI. Both groups were surveyed by questionnaires using the ICIQ-FLUTS and OABSS. Results The incidence of LUTS in the cervical cancer group(78.3%, 540/690) was similar to that in the control group(78.7%, 543/690)(P > 0.05). The prevalence of storage symptoms in the cervical cancer group(66.2%, 457/690) was lower than that in the control group(75.5%, 521/690)(P < 0.05), while the prevalence of voiding symptoms in the cervical cancer group(52.3%, 361/690) and OAB(14.5%, 100/690) was significantly higher than that in the control group(24.1%, 166/690;8.8%, 61/690)(P < 0.05). Univariate analysis showed that laparoscopic surgery, resection of cardinal-ligament and uterosacral-ligament length or vaginal length > 3 cm was associated with voiding symptoms and OAB(P < 0.05). Logistic analysis showed that laparoscopic surgery was a risk factor for voiding symptoms and OAB(OR = 2.380, 95% CI : 1.664-3.405;OR =1.972, 95%CI : 1.155-3.367). Conclusion After RH Ⅲ, the morbidity of voiding symptoms and OAB was increased, and it may be related to excision of more tissue of parametrium and vagina.