LNSRH对宫颈癌术后盆底功能及生活质量的影响研究
发布时间：2019-01-08 08:12
【摘要】：背景宫颈癌是女性第二大恶性肿瘤,严重危害妇女健康。传统广泛性子宫切除术(radical hysterectomy,RH)联合盆腔淋巴结清扫术是早期宫颈癌的主要手术方式,其5年生存率可超过80%。但RH在获得疗效的同时,损伤了盆腔自主神经,造成一系列盆底功能障碍并发症,主要表现为膀胱,肛门直肠和性功能障碍,降低患者术后生活质量。为了在延长生存期的同时,改善术后生活质量,保留盆腔自主神经广泛性子宫切除术成为目前治疗趋势。由于腹腔镜技术的独特优势,特别是其放大视野作用,为术中神经辨认提供便捷,腹腔镜下保留盆腔自主神经广泛性子宫切除术逐渐得到推广。2008年保留盆腔自主神经广泛性子宫切除术正式列入了宫颈癌新的手术分级中。目的分析比较宫颈癌患者腹腔镜下保留盆腔自主神经广泛性子宫切除术(laparoscopic nerve-sparing radical hysterectomy,LNSRH)及传统腹腔镜下广泛性子宫切除术(laparoscopic radical hysterectomy,LRH)两种术式术后盆底功能恢复及生活质量情况,探讨LNSRH对患者盆底功能及生活质量的影响。方法收集2012年-2014年FIGO临床分期为Ⅰb1~Ⅱa2期,于我院接受LNSRH(观察组,138例)和LRH(对照组,138例)的宫颈癌患者临床资料,进行回顾性队列研究,观察两种手术对患者术后膀胱、直肠及性功能恢复的影响,综合评价患者术后生活质量情况。结果所有患者均顺利完成手术,两组患者在术中出血量、淋巴结切除数目、阴道壁切除长度、手术时间、死亡率及复发率等方面比较差异均无统计学意义(P0.05),而LNSRH组术后住院时间较LRH组缩短(P0.05)。术后膀胱直肠功能恢复情况:LNSRH组留置尿管天数主要集中在7~14 d,而LRH组主要集中在15d,差异有统计学意义(P0.05);泌尿系统并发症LNSRH组较LRH组减少(P0.05)。LNSRH组术后首次肛门排气时间及排便时间均较LRH组缩短,且术后消化系统并发症减少(P0.05)。LNSRH组术后I-QOL及PFIQ-7评分均优于LRH组(P0.05)。术后性功能恢复情况:两组患者术后性功能指数(FSFI)调查评分,术前两组各个领域与总分无明显差异(P0.05),术后LNSRH组在性欲望、主观性唤起能力、性生活满意度三个领域评分优于LRH组(P0.05),在性活动时阴道润滑性、性高潮及性交痛方面差异无统计学意义(P0.05)。总评分LNSRH组明显优于LRH组(P0.01)。术后生活质量情况:两组术后生活质量简易问卷(SF-36)评分情况,LNSRH组生理综合(PCS)得分,心理综合(MCS)得分及问卷总分均高于LRH组,差异有统计学意义(P0.01)。结论LNSRH作为早期宫颈癌手术治疗方式是安全可行的,与LRH相比更有助于患者术后膀胱、直肠及性功能等盆底器官功能恢复,并在一定程度上改善患者术后生活质量。
[Abstract]:Background Cervical cancer is the second largest malignant tumor in women, which seriously endangers women's health. Conventional extensive hysterectomy (radical hysterectomy,RH) combined with pelvic lymph node dissection is the main surgical procedure for early cervical cancer, with a 5-year survival rate of more than 80%. At the same time, RH injured the pelvic autonomic nerve and caused a series of complications of pelvic floor dysfunction, mainly manifested as bladder, anorectal and sexual dysfunction, and reduced the postoperative quality of life of the patients. In order to prolong the survival time and improve the quality of life after operation, extensive hysterectomy with pelvic autonomic nerve preservation has become the current treatment trend. Because of the unique advantage of laparoscopic technique, especially its effect of magnifying the visual field, it is convenient to recognize the nerve during operation. Extensive hysterectomy with pelvic autonomic nerve preservation was gradually popularized under laparoscope. In 2008, pelvic autonomic nerve preserving extensive hysterectomy was officially included in the new surgical classification of cervical cancer. Objective to analyze and compare laparoscopic pelvic autonomic nerve preserving extensive hysterectomy (laparoscopic nerve-sparing radical hysterectomy,LNSRH) with conventional laparoscopic (laparoscopic radical hysterectomy, in patients with cervical cancer. To explore the effect of LNSRH on pelvic floor function and quality of life (QOL). Methods the clinical data of patients with cervical cancer receiving LNSRH (observation group, 138 cases) and LRH (control group, 138 cases) were collected from 2012 to 2014. To observe the effect of two kinds of operation on the recovery of bladder, rectum and sexual function, and to evaluate the quality of life after operation. Results all the patients completed the operation successfully. There was no significant difference in the amount of blood loss, the number of lymph nodes excision, the length of vaginal wall resection, the operative time, the mortality rate and the recurrence rate between the two groups (P0.05). The postoperative hospitalization time of LNSRH group was shorter than that of LRH group (P0.05). Postoperative recovery of bladder and rectum function: the days of indwelling urinary catheter in LNSRH group was 714 days, while that in LRH group was 15 days, the difference was statistically significant (P0.05). Urinary system complications in LNSRH group were shorter than those in LRH group (P0.05). The first anal exhaust time and defecation time in). LNSRH group were shorter than those in LRH group. Postoperative digestive system complications decreased (P0.05). LNSRH group, I-QOL and PFIQ-7 scores were better than LRH group (P0.05). Postoperative sexual function recovery: the (FSFI) score of postoperative sexual function index was not significantly different between the two groups before operation (P0.05), LNSRH group in sexual desire, subjective arousal ability, The score of sexual satisfaction in three areas was better than that in LRH group (P0.05), but there was no significant difference in vaginal lubricity, orgasm and sexual intercourse pain during sexual activity (P0.05). The total score of LNSRH group was significantly better than that of LRH group (P0.01). Quality of life (QOL): the score of simple questionnaire (SF-36) for postoperative quality of life in two groups, the score of comprehensive physiological (PCS), the score of psychological comprehensive (MCS) and the total score of questionnaire in LNSRH group were higher than those in LRH group, and the difference was statistically significant (P0.01). Conclusion LNSRH is safe and feasible as a surgical treatment for early cervical cancer. Compared with LRH, it is more helpful for the recovery of pelvic floor organ function, such as bladder, rectum and sexual function, and improves the postoperative quality of life to a certain extent.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
本文编号：2404338
[Abstract]:Background Cervical cancer is the second largest malignant tumor in women, which seriously endangers women's health. Conventional extensive hysterectomy (radical hysterectomy,RH) combined with pelvic lymph node dissection is the main surgical procedure for early cervical cancer, with a 5-year survival rate of more than 80%. At the same time, RH injured the pelvic autonomic nerve and caused a series of complications of pelvic floor dysfunction, mainly manifested as bladder, anorectal and sexual dysfunction, and reduced the postoperative quality of life of the patients. In order to prolong the survival time and improve the quality of life after operation, extensive hysterectomy with pelvic autonomic nerve preservation has become the current treatment trend. Because of the unique advantage of laparoscopic technique, especially its effect of magnifying the visual field, it is convenient to recognize the nerve during operation. Extensive hysterectomy with pelvic autonomic nerve preservation was gradually popularized under laparoscope. In 2008, pelvic autonomic nerve preserving extensive hysterectomy was officially included in the new surgical classification of cervical cancer. Objective to analyze and compare laparoscopic pelvic autonomic nerve preserving extensive hysterectomy (laparoscopic nerve-sparing radical hysterectomy,LNSRH) with conventional laparoscopic (laparoscopic radical hysterectomy, in patients with cervical cancer. To explore the effect of LNSRH on pelvic floor function and quality of life (QOL). Methods the clinical data of patients with cervical cancer receiving LNSRH (observation group, 138 cases) and LRH (control group, 138 cases) were collected from 2012 to 2014. To observe the effect of two kinds of operation on the recovery of bladder, rectum and sexual function, and to evaluate the quality of life after operation. Results all the patients completed the operation successfully. There was no significant difference in the amount of blood loss, the number of lymph nodes excision, the length of vaginal wall resection, the operative time, the mortality rate and the recurrence rate between the two groups (P0.05). The postoperative hospitalization time of LNSRH group was shorter than that of LRH group (P0.05). Postoperative recovery of bladder and rectum function: the days of indwelling urinary catheter in LNSRH group was 714 days, while that in LRH group was 15 days, the difference was statistically significant (P0.05). Urinary system complications in LNSRH group were shorter than those in LRH group (P0.05). The first anal exhaust time and defecation time in). LNSRH group were shorter than those in LRH group. Postoperative digestive system complications decreased (P0.05). LNSRH group, I-QOL and PFIQ-7 scores were better than LRH group (P0.05). Postoperative sexual function recovery: the (FSFI) score of postoperative sexual function index was not significantly different between the two groups before operation (P0.05), LNSRH group in sexual desire, subjective arousal ability, The score of sexual satisfaction in three areas was better than that in LRH group (P0.05), but there was no significant difference in vaginal lubricity, orgasm and sexual intercourse pain during sexual activity (P0.05). The total score of LNSRH group was significantly better than that of LRH group (P0.01). Quality of life (QOL): the score of simple questionnaire (SF-36) for postoperative quality of life in two groups, the score of comprehensive physiological (PCS), the score of psychological comprehensive (MCS) and the total score of questionnaire in LNSRH group were higher than those in LRH group, and the difference was statistically significant (P0.01). Conclusion LNSRH is safe and feasible as a surgical treatment for early cervical cancer. Compared with LRH, it is more helpful for the recovery of pelvic floor organ function, such as bladder, rectum and sexual function, and improves the postoperative quality of life to a certain extent.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
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相关期刊论文 前3条
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