阴式与腹腔镜子宫切除术对患者下尿路功能及盆底结构的影响比较

Comparison on the Influence of Vaginal and Laparoscopic Hysterectomy for Lower Urinary Tract Function and Pelvic Floor Structure of Patients

目的:探究阴式与腹腔镜子宫切除术对患者下尿路功能及盆底结构的影响。方法:将2021年10月—2023年1月孝感市孝南区妇幼保健院的120例子宫切除术患者根据随机数字表法将其分为A组(n=60)和B组(n=60)。A组进行腹腔镜子宫切除术治疗,B组采取阴式子宫切除术治疗。比较两组的手术时间、术中出血量、肠鸣音恢复时间、排气时间、应激激素[β-内啡肽(β-EP)及皮质醇(Cor)]、下尿路功能[最大尿流率(Q_(max))及残余尿量(PVR)]及盆底结构(静息和最大瓦氏动作时膀胱尿道后角及膀胱颈到耻骨联合下缘的距离)。结果:B组的手术时间短于A组,肠鸣音恢复时间及排气时间均显著早于A组,术中出血量显著少于A组,差异均有统计学意义(P<0.05)。术后1、3 d两组的应激反应指标均显著高于术前,且B组均显著低于A组,差异均有统计学意义(P<0.05)。术前和术后1、3个月,两组的下尿路功能及盆底结构指标比较,差异均无统计学意义(P>0.05);术后1、3个月,两组的PVR、静息和最大瓦氏动作时膀胱尿道后角显著均大于术前,Qmax均低于术前,膀胱颈到耻骨联合下缘的距离均显著短于术前,差异均有统计学意义(P<0.05)。结论:阴式子宫切除术对患者机体应激激素的影响显著小于腹腔镜子宫切除术,两类术式均可影响患者的下尿路功能及盆底结构,但其影响程度无显著差异。

Objective:To investigate the influence of vaginal and laparoscopic hysterectomy for lower urinary tract function and pelvic floor structure of patients.Method:A total of 120 patients with hysterectomy in Xiaonan District Maternal and Child Health Hospital of Xiaogan City from October 2021 to January 2023 were divided into group A(n=60)and group B(n=60)by the random number table method.The group A was treated with laparoscopic hysterectomy,the group B was treated with vaginal hysterectomy.Then the operation time,intraoperative blood loss,bowel sound recovery time,exhaust time,stress hormones[β-endorphin(β-EP)and cortisol(Cor)],lower urinary tract function[maximum flow rate(Q_(max)),and postvoid residual urine urine(PVR)]and pelvic floor structure indexes(posterior vesicourethral angle and distance from the bladder neck to the lower edge of pubic symphysis at resting and Valsalva state)of two groups were compared.Result:The operation time of the group B was shorter than that in the group A,bowel sound recovery time and exhaust time of group B were significantly earlier than those of group A,the intraoperative blood loss was significantly less than that of group A,the differences were statistically significant(P<0.05).1 and 3 d after operation,the stress response indicators of the two groups were significantly higher than those before operation,and those in group B were significantly lower than those in group A,the differences were statistically significant(P<0.05).There were no statistically significant differences in lower urinary tract function and pelvic floor structure indicators between the two groups before and 1 and 3 months after operation(P>0.05);1,3 months after the operation,the PVR,posterior vesicourethral angle at resting and Valsalva state of two groups were significantly greater than those before the operation,Qmax were significantly lower than those before the operation,the distance from the bladder neck to the lower edge of pubic symphysis were significantly shorter than those before the operation,the differences were statistically significant(P<0.05).Conclusion:The influence of vaginal hysterectomy for body stress hormones of patients are smaller than those of laparoscopic hysterectomy,and the two operations both can affect the lower urinary tract function and pelvic floor structure of patients,while their influence degree are not statistically significant.