保留盆腔自主神经根治性子宫切除术术后患者直肠功能、性功能的调查研究及生存分析

发布时间：2018-08-26 16:34

【摘要】：根治性子宫与盆腔淋巴结切除术是治疗早期宫颈癌主要的有效方法，且有较高的累积5年生存率高。宫颈治疗后生存患者期待更好的生活质量，生存率的升高也使得国内外妇科肿瘤医师医师不断的改进治疗方法。而最有效的常规宫颈癌根治术由于切除范围过大容易损伤盆腔自主神经，导致术后出现膀胱、直肠和性功能障碍。NSRH手术在早期宫颈癌治疗中因保护了盆腔神经而得到广泛的应用。我们曾对首次在我院就诊并接受进行了保神经手术的患者，对其进行术后膀胱功能、近期直肠功能评估，得出保留盆腔自主神经根治性子宫切除术具有可行性和安全性，有利于术后膀胱、直肠功能的恢复的结论。本研究分两部分探讨NSRH术的优势及安全性：1、将通过调查问卷、电话随访、书信随访形式对接受保神经手术术后的患者远期直肠功能、性功能的调查研究；2、保神经手术的生存分析。保留盆腔自主神经广泛全子宫切除术术后患者直肠功能、性功能的调查研究目的对NSRH手术与同期RH术术后远期直肠、性功能方面的调查研究。方法选择2008年03月~2013年12月期间，于广西医科大学附属肿瘤医院72例FIGO Ib1~Ⅱb期符合并接受NSRH手术（即Q-M手术分型的C1型）治疗的患者，且有完整随访资料的患者为研究组。对照组选择72例随机抽取接受Q-M手术分型的C2型的宫颈癌根治术的无复发患者。回顾性分析两组患者在接受手术后的远期直肠功能和性功能。结果两组患者术后直肠功能情况调查结果：保神经手术组（NSRH组）伴有腹泻、便秘症状的比例分别为4.2%、6.9%，未保神经手术组（RH组）的分别为33.3%、38.9%,差异显著（P＜0.05）；两组大便失禁情况无显著差异（P＞0.05）两组患者术后性功能情况调查评分结果汇总如表六所示：两组的除性欲望外，性兴奋、性润滑、性高潮、满意度、性疼痛情况和总分均有显著差异（P＜0.05）。结论NSRH手术在一定程度上能减轻远期直肠功能、性功能障碍的发生。保留盆腔自主神经根治性全子宫切除术的生存分析目的探讨NSRH术治疗早期宫颈癌的疗效及对患者预后的影响。方法收集2008年03月~2013年08月广西医科大学附属肿瘤医院首次接受NSRH治疗的宫颈癌患者84例，治疗前由两名及两名以上妇科肿瘤专业医师进行双合诊及三合诊检查，按国际妇产科联盟（International Federation ofGynecology and Obstetric，FIGO）2009年临床分期诊断为Ⅰb1~Ⅱb期为研究组。为了消除偏倚，选出与相同期间、相同FIGO分期、同一术者的87例初次接受RH手术的宫颈癌患者与研究组进行配对：两组患者的年龄、体重指数(BMI)、肿瘤病理类型、临床分期等差异均无统计学意义。结果NSRH组和RH组的累积5年总生存率分别为98.6%和93.0%，中位生存时间分别为25.5个月和26个月；NSRH组和RH组的累积5年无瘤生存率分别为98.6%和90.8%，均差异无统计学意义（P＞0.05）。在一定程度上讲NSRH手术是安全可行的。结论NSRH用于早期宫颈癌的治疗与RH手术相比，，有恢复快、保留尿管时间短、住院时间短以及长期生活质量有不同程度的改善等优点的优点，而且是安全有效的。
[Abstract]:Radical hysterectomy and pelvic lymphadenectomy are the main effective methods for the treatment of early cervical cancer, and the cumulative 5-year survival rate is high. Patients who survive after cervical treatment expect better quality of life. The rising survival rate also makes gynecologists and oncologists at home and abroad constantly improve the treatment methods. Radical resection of the pelvic autonomic nerve may lead to postoperative bladder, rectum and sexual dysfunction. NSRH has been widely used in the treatment of early cervical cancer because of the protection of the pelvic nerve. We have had the first time in our hospital and underwent nerve-conserving surgery for patients with postoperative bladder. Cystectomy with pelvic autonomic nerve preservation is feasible and safe, which is beneficial to the recovery of bladder and rectal function. This study is divided into two parts to explore the advantages and safety of NSRH: 1. Through questionnaires, telephone follow-up and letter follow-up, the acceptance of NSRH will be protected. Long-term rectal function and sexual function of patients after surgery; 2. Survival analysis of nerve-preserving surgery.
Investigation of rectal function and sexual function in patients with pelvic autonomic nerve preservation after total hysterectomy
Objective to investigate the long-term rectal and sexual function after NSRH operation and RH.
Methods From March 2008 to December 2013, 72 cases of cervical cancer with FIGO Ib1~II B stage conforming to and receiving NSRH operation (type C1 of Q-M operation type) and complete follow-up data were selected as the study group. 72 cases of cervical cancer with Q-M operation type C2 were randomly selected as the control group. The long-term rectal and sexual functions of the two groups were analyzed retrospectively.
Results Two groups of patients with rectal function survey results: nerve-conserving surgery group (NSRH group) with diarrhea, constipation symptoms were 4.2%, 6.9%, non-nerve-conserving surgery group (RH group) were 33.3%, 38.9%, the difference was significant (P < 0.05); two groups of patients with fecal incontinence was not significantly different (P > 0.05). The scores were summarized as shown in Table 6. Except for sexual desire, there were significant differences in sexual excitement, sexual lubrication, orgasm, satisfaction, sexual pain and total score between the two groups (P < 0.05).
Conclusion NSRH operation can reduce long-term rectal function and sexual dysfunction.
Survival analysis of pelvic autonomic nerve radical hysterectomy
Objective to investigate the efficacy and prognosis of NSRH in the treatment of early cervical cancer.
Methods From March 2008 to August 2013, 84 patients with cervical cancer who were first treated with NSRH in Cancer Hospital Affiliated to Guangxi Medical University were enrolled. Before treatment, two or more gynecological oncologists performed double and triple consulting examinations according to the International Federation of Gynecology and Obstetric (FIGO) in 2009. In order to eliminate the bias, 87 patients with cervical cancer who underwent RH for the first time were selected and matched with the study group. There were no significant differences in age, body mass index (BMI), tumor pathological type and clinical stage between the two groups.
Results The cumulative 5-year overall survival rates in NSRH and RH groups were 98.6% and 93.0% respectively, and the median survival time was 25.5 months and 26 months, respectively. The cumulative 5-year tumor-free survival rates in NSRH and RH groups were 98.6% and 90.8% respectively, with no significant difference (P > 0.05).
Conclusion Compared with RH, NSRH has the advantages of faster recovery, shorter retention time, shorter hospitalization time and better long-term quality of life.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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