腹腔镜与开腹根治性子宫切除术后排尿和排便功能障碍的发生情况比较

Comparison in postoperative urination and defecation dysfunctions between laparoscopic and open radical hysterectomy

目的探讨腹腔镜根治性子宫切除术后排尿、排便功能障碍的发生情况。方法将50例行根治性子宫切除术的宫颈癌患者根据手术方式分为腹腔镜组和开腹组,每组25例。比较2组患者术后排尿、排便功能恢复情况。结果腹腔镜组术后住院时间、肛门排气时间、术中失血量均短于、低于开腹组,手术时间长于开腹组,差异有统计学意义(P<0.05或P<0.01)。开腹组发生尿失禁、急迫性尿失禁和膀胱敏感性上升的患者比率高于腹腔镜组,差异有统计学意义(P<0.05或P<0.01)。术后6个月时,腹腔镜组Wexner便秘评分系统(CSS)评分低于开腹组,差异有统计学意义(P<0.05)。开腹组放化疗者术后6个月时CSS评分高于术前,腹腔镜组放化疗者术后6个月时佛罗里达克利夫兰诊所大便失禁评分(CCF-FIS)评分高于术前,差异均有统计学意义(P<0.05)。结论与开腹手术相比,腹腔镜根治性子宫切除术可以减少术后急迫性大小便失禁、膀胱感觉增强和便秘等远期并发症的发生。

Objective To explore the incidence of urination and defecation dysfunctions after laparoscopic radical hysterectomy.Methods Totally 50 cervical cancer patients with radical hysterectomy were divided into laparoscopy group and open surgery group according to the operation methods,with 25 cases in each group.The recovery conditions of postoperative urination and defecation functions were compared between the two groups.Results The postoperative hospital stay,anal exhaust time and intraoperative blood loss of the laparoscopic group were significantly lower or shorter than those of the open surgery group,while the operation time was significantly longer than the control group(P<0.05 or P<0.01).The ratios of patients with urinary incontinence,urgent urinary incontinence and increased bladder sensitivity in the open surgery group were significantly higher than that in the laparoscopy group(P<0.05 or P<0.01).At 6 months after operation,the score of Wexner Constipation Score System(CSS)in the laparoscopy group was significantly lower than that in the open surgery group(P<0.05).The CSS score at 6 months after operation in the patients with chemoradiotherapy in the open surgery group was significantly higher than that before operation,and the score of the Fecal Incontinence Score of Cleveland Clinic in Florida(CCF-FIS)at 6 months after operation in the laparoscopy group was significantly higher than that before operation(P<0.05).Conclusion Compared with open surgery,laparoscopic radical hysterectomy can reduce the incidence of long-term complications such as urgent urinary and fecal incontinence,bladder sensation enhancement and constipation.