广泛性子宫切除术后相关并发症的动态观察

发布时间：2018-04-01 01:06

本文选题：广泛子宫切除术　切入点：宫颈癌　出处：《南方医科大学》2014年硕士论文

【摘要】：目的：观察因宫颈癌与子宫内膜癌行广泛性子宫切除术(Radical Hysterectomy, RH),患者术后各随访时间点并发症的表现与发生率。方法：前瞻性观察在南方医科大学南方医院144例患者,因妇科恶性肿瘤行广泛子宫切除术(Radical Hysterectomy, RH),记录其围手术期的损伤情况及术前、术后1月、3月、6月、1年、2年、3年、4年、5年的膀胱功能障碍、肛门直肠功能紊乱、性功能障碍等的主观症状的发生率,以术后有无放疗进行分组,放疗组57例,非放疗组87例,评估放疗对并发症发生的影响。以Epidata3.1双输入建立数据文件库,导出至SPSS13.0行统计分析。结果：144例患者,目前在访109人,总计随访6163人月。其中在访放疗患者42人,无放疗67人。(1)平均留置尿管时间(29.2±31.8)天,85例患者发生尿潴留(膀胱残余尿量100m1),占59.0%。 (2)膀胱功能障碍表现排尿困难、尿不净感、腹压排尿等,在术后1月、3月、6月总发生率分别为81.9%、74.7%、59.2%,明显高于术前；术后1年、2年发生率与术前无统计学差异；腹压排尿持续存在至术后5年甚至更长。腹压排尿术后1年放疗组明显高于无放疗组,张力性尿失禁术后3月放疗组明显高于无放疗组 (3)肛门直肠功能紊乱的发生率：肛门直肠功能紊乱以排便不净感、排便习惯改变、便秘等表现为主；术后1月总发生率为55.4%,明显高于术前；术后3月与术后1月相比亦有较高趋势,但无明显统计学差异,术后6月、1年、2年的肛门直肠功能紊乱总发生率与术前均无统计学差异。非炎性腹泻或大便次数增多术后3月放疗组明显高于无放疗组。 (4)性功能障碍：术后3月、6月恢复性生活的比率明显低于术前,术后1年后逐渐至恢复术前水平；性功能障碍以副交感神经损伤症状,以性唤起障碍、性交痛、阴道干燥、阴道弹性下降等为主；术后3、6月、1年、2年的总发生率分别为88.5%、82.4%、87.5%,明显高于术前。性交痛、阴道干燥与阴道痉挛术后3、6月、1年放疗组明显高于无放疗组结论：广泛子宫切除术(RH)的并发症以盆腔自主神经损伤为主要表现,尤其是副交感神经损伤的盆腔器官功能障碍为主。 1、膀胱功能障碍表现较为严重,发生率呈先升高后降低的趋势,术后1年内症状多样,发生率明显高于术前,1年后以腹压排尿表现为主,且持续存在,其余症状在腹压排尿的代偿下消失。 2、肛门直肠功能紊乱主要表现为大便干结,其发生率呈先上升后降低的趋势,术后6月肛门直肠功能紊乱可逐渐恢复。 3、性功能障碍发生率高且持续存在。 4、放疗对于RH术后并发症的影响：放疗对于性功能损伤较为明显,但对膀胱功能、肛门直肠功能的影响不明显。
[Abstract]:Objective: to observe the incidence and manifestation of postoperative complications after radical hysterectomy for cervical carcinoma and endometrial carcinoma.Methods: 144 patients with gynecological malignant tumors were studied prospectively. The perioperative injury and preoperative injury were recorded.The incidence of the subjective symptoms of bladder dysfunction, anorectal dysfunction, sexual dysfunction, and so on in patients with bladder dysfunction, anorectal dysfunction, and sexual dysfunction was divided into two groups: radiotherapy group (n = 57) and non-radiotherapy group (n = 87), according to whether there was radiotherapy or not, in the first month, 3 months, 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after operation.To evaluate the effect of radiotherapy on complications.The data file library is established by Epidata3.1 double input, and exported to SPSS13.0 row statistical analysis.Results of the 144 patients, 109 were currently interviewed, with a total follow-up of 6163 person-months.The average indwelling time of urethral catheter was 29.2 卤31.8days in 42 patients with radiotherapy and 67 patients without radiotherapy. The retention of urine was observed in 85 patients (bladder residual urine volume was 100m1g, 59.0%).(2) the incidence of dysuria, dysuria, abdominal pressure and dysuria were 81.9%, 74.74.2% and 59.2% respectively in 1 month, 3 months and 6 months after operation, which were significantly higher than those before operation, but there was no significant difference in the incidence of 1 year and 2 years after operation.Abdominal pressure urination persisted until 5 years or more after operation.One year after abdominal pressure urination, radiotherapy group was significantly higher than that without radiotherapy group, and tension urinary incontinence group was significantly higher than no radiotherapy group in 3 months after operation.(3) the incidence of anorectal dysfunction: the main symptoms of anorectal dysfunction were defecation, defecation habits change, constipation, etc. The total incidence of anorectal dysfunction was 55.45.45%, which was significantly higher than that before operation.The total incidence of anorectal dysfunction in 6 months, 1 year and 2 years after operation was not significantly different from that before operation.The number of non-inflammatory diarrhea or stool increased significantly in radiotherapy group 3 months after operation than in non-radiotherapy group.(4) sexual dysfunction: the recovery rate of sexual life in 3 months and 6 months after operation was significantly lower than that before operation, and gradually recovered to the preoperative level 1 year after operation; sexual dysfunction was characterized by parasympathetic nerve injury, sexual arousal disorder, sexual intercourse pain, and vaginal dryness.The total incidence of vaginal elasticity was 82.4%, 87.5% and 87.5% respectively, which was significantly higher than that before operation, 3 months, 6 months, 1 year and 2 years after operation.Sexual intercourse pain, vaginal dryness and vagina spasm were significantly higher in radiotherapy group than in non-radiotherapy group 3, 6 months and 1 year after operation.Conclusion: the main complication of extensive hysterectomy is pelvic autonomic nerve injury, especially the pelvic organ dysfunction caused by parasympathetic nerve injury.1. The bladder dysfunction was more serious, the incidence rate increased first and then decreased. The symptoms were various in one year after operation, and the incidence rate was obviously higher than that before operation. After one year, abdominal pressure urination was the main manifestation, and it persisted.The rest of the symptoms disappeared under the compensatory effect of abdominal pressure on urination.2. The anorectal dysfunction was mainly characterized by stool dry knot, the incidence of which increased first and then decreased. The anorectal dysfunction could be gradually recovered 6 months after operation.3. The incidence of sexual dysfunction is high and persistent.4. The effect of radiotherapy on postoperative complications of RH: the effect of radiotherapy on sexual function injury was obvious, but not on bladder function and anorectal function.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.42

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