不同时机盆底康复治疗对宫颈癌PiverⅢ型子宫切除术患者术后盆底功能的影响

Effect of pelvic floor rehabilitation at different time on pelvic floor function in patients with cervical cancer after PiverⅢhysterectomy

目的:探讨不同时机盆底康复治疗对宫颈癌PiverⅢ型子宫切除术患者术后尿潴留、留置尿管时间、排尿功能、盆底肌电生理功能及盆底功能障碍的影响。方法:选取2019年01月至2020年06月在我院妇科行PiverⅢ型子宫切除术+双侧盆腔淋巴结清扫术并经术后病理结果证实的宫颈癌患者64例为研究对象。按照随机数字表法分组,最终纳入观察组与对照组,各30例。观察组术后7天开始盆底康复治疗,对照组术后14天开始盆底康复治疗,两组的盆底康复治疗方法、疗程一致。比较两组患者术后尿潴留情况及留置尿管时间;于治疗前、术后1个月、术后3个月观察比较两组患者自由尿流率、盆底肌电生理功能、盆底功能障碍评价。结果:观察组患者尿潴留发生率低于对照组(P<0.05);观察组患者留置尿管时间短于对照组(P<0.05)。术后1个月、术后3个月,观察组患者最大尿流率(Q_(max))、平均尿流率(Q_(ave))及排尿量高于对照组(P<0.05);观察组患者排尿时间、残余尿量低于对照组(P<0.05);观察组患者Ⅰ、Ⅱ类肌纤维肌力、盆底动态压力、肌电位高于对照组(P<0.05);观察组患者POPDI-6、CRADI-8、UDI-6及PFDI-20总分低于对照组(P<0.05)。结论:早期介入盆底康复治疗可有效降低宫颈癌行PiverⅢ型子宫切除术患者术后尿潴留发生率,缩短尿管留置时间,并提高盆底肌力,改善盆底功能。

Objective:To investigate the effect of different pelvic floor rehabilitation on postoperative urinary retention,indwelling catheter time,voiding function,pelvic floor electromyography and pelvic floor dysfunction in patients with cervical cancer after PiverⅢhysterectomy.Methods:From January 2019 to June 2020,64 patients in our hospital underwent PiverⅢhysterectomy+bilateral pelvic lymphadenectomy and confirmed by pathological results for cervical cancer were selected as the research objects.They were divided into observation group and control group according to random number table,30 cases in each group.The observation group started pelvic floor rehabilitation treatment 7 days after operation,and the control group started pelvic floor rehabilitation treatment 14 days after operation.The pelvic floor rehabilitation method and course of treatment of the two groups were the same.The postoperative urinary retention and the time of indwelling catheter were compared between the two groups.The free urinary flow rate,pelvic floor electrophysiological function and pelvic floor dysfunction of the two groups were observed and compared before treatment,1 month and 3 months after operation.Results:The incidence of urinary retention and the time of indwelling catheter in observation group were lower than that in control group(P<0.05).The maximum flow rate(Q_(max)),average flow rate(Q_(ave))and urine output of the observation group were higher than those of the control group at 1 month and 3 months after operation(P<0.05).The micturition time and residual urine volume of the observation group were lower than those of the control group(P<0.05).The muscle strength,pelvic floor dynamic pressure and muscle potential of classⅠandⅡmuscle fibers in the observation group were higher than those in the control group(P<0.05).The total scores of POPDI-6,CRADI-8,UDI-6 and PFDI-20 in the observation group were lower than those in the control group(P<0.05).Conclusion:Early intervention pelvic floor rehabilitation therapy can effectively reduce the incidence of postoperative urinary retention in patients with cervical cancer undergoing PiverⅢhysterectomy,shorten the indwelling time of the catheter,improve pelvic floor muscle strength and improve pelvic floor function.