基于膜解剖理论的保留盆腔自主神经根治术治疗宫颈癌效果及术后盆底肌功能障碍性疾病的影响因素分析

Analysis of the Therapeutic Effect of Pelvic Autonomic Nerve Preservation Radical Surgery Based on Membrane Anatomy Theory on Cervical Cancer and the Influencing Factors of Postoperative Pelvic Floor Muscle Dysfunction Disease

目的分析比较基于膜解剖理论的保留盆腔自主神经宫颈癌根治术(NSRH)与广泛性子宫切除术(RH)2种手术后效果并分析患者术后盆底肌功能障碍性疾病(PFD)的影响因素。方法选取2022年1月至2023年12月入院治疗的102例ⅠB1~ⅡA1期宫颈鳞癌患者作为研究对象。根据手术方式差异分为试验组48例(基于膜解剖理论开腹NSRH)与对照组54例(RH),对比2组手术相关情况、术后结直肠功能恢复情况、术后并发症情况以及PFD的影响因素。结果试验组住院时间少于对照组(P<0.05),试验组在术中出血量、留置尿管时间、肛门排气时间、术后排便时间少于对照组,且具有统计学意义(P<0.05)。试验组术口感染为1例,PFD为16例。对照组肠梗阻1例,淋巴结囊肿2例,膀胱损伤1例以及PFD37例。试验组PFD的发生率低于对照组(P<0.05)。102例患者术后共发生53例PFD,有无绝经、肿瘤直径、留置尿管时间、妊娠次数以及手术方式为术后发生PFD的影响因素(P<0.05)。患者绝经、留置尿管时间、妊娠次数以及手术方式是术后PFD发生的独立危险因素。结论基于膜解剖理论开腹NSRH术后指标优于RH,PFD发生率低于RH。绝经、留置尿管时间长、妊娠次数多及手术方式是PFD的独立危险因素。

Objective To analyze and compare the postoperative effects of two types of radical surgery for cervical cancer based on membrane anatomy theory:pelvic autonomic nerve preservation radical surgery(NSRH)and extensive hysterectomy(RH),as well as the influencing factors of postoperative pelvic floor muscle dysfunction(PFD)in patients.Methods 102 patients with stageⅠB1~ⅡA1 cervical squamous cell carcinoma admitted for treatment from January 2022 to December 2023 were selected as the study subjects.According to the surgical method,they were divided into an experimental group of 48 cases(Open NSRH based on membrane anatomy theory)and a control group of 54 cases(RH).The two groups were compared with the surgery-related conditions,postoperative colorectal function recovery,postoperative complications,and factors affecting PFD.Results The hospitalization time of the experimental group was shorter than that of the control group(P<0.05),and the experimental group had lower intraoperative bleeding volume,shorter indwelling catheter time,shorter anal emptying time,and shorter postoperative defecation time compared to the control group,with statistical differences(P<0.05).There was 1 case of surgical infection and 16 cases of PFD in the experimental group.There was 1 case of intestinal obstruction,2 cases of lymph node cysts,1 case of bladder injury,and 37 cases of PFD in the control group.The incidence of PFD in the experimental group was lower than that in the control group(P<0.05).A total of 53 cases of PFD occurred in 102 patients after surgery,and the factors affecting the occurrence of PFD were menopause,tumor diameter,indwelling catheter time,number of pregnancies,and surgical method(P<0.05).Menopause,duration of indwelling catheters,number of pregnancies,and surgical methods are independent risk factors for postoperative PFD in patients.Conclusion Based on the theory of membrane anatomy,open abdominal NSRH has better postoperative indicators than RH,and the incidence of PFD is lower than RH.Menopause,prolonged indwelling catheterization,multiple pregnancies,and surgical methods are independent risk factors for PFD.