系统保留盆腔自主神经的广泛性子宫切除术对膀胱功能的影响

发布时间：2018-03-08 12:32

本文选题：SNSRH　切入点：RH　出处：《延安大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过比较SNSRH与RH患者术前、术中、术后相关指标,探讨SNSRH术式临床应用的安全性、可行性、有效性以及对保留盆腔自主神经的意义和改善术后膀胱功能的作用,从而为临床提供可靠的理论依据,达到降低患者术后并发症及提高其生存质量的目的。方法:选取2015年1月至2017年2月期间就治于延安大学附属医院妇科病区的宫颈癌患者60例作为前瞻性研究对象,分为SNSRH组和RH组,SNSRH组30例符合并且行SNSRH手术,RH组30例行常规RH手术。对比分析两组患者的平均出血量、平均手术时间、切除子宫主韧带、骶韧带及阴道前、后壁长度、再次留置尿管次数、切缘病理情况、切除子宫主、骶和膀胱宫颈韧带切缘神经分布状态以及术前、术后尿动力学检查相关参数。所有入选研究指标都使用Microsoft Excel软件建立数据库并且应用SPSS 22.0软件包进行统计学分析。结果:1.SNSRH组与RH组平均手术时间比较,差异有统计学意义(P0.05)。SNSRH组与RH组术中平均出血量、切除子宫主韧带、骶韧带及阴道前、后壁长度、切缘病理情况方面,差异均无统计学意义(P0.05)。2.SNSRH组与RH组在切除子宫主、骶和膀胱宫颈韧带切缘神经分布状态方面对比分析,差异具有统计学意义(P0.05)。3.SNSRH组与RH组在再次留置尿管次数及术前、术后尿动力学检查相关参数方面比较,差异有统计学意义(P0.05)。结论:1.SNSRH较RH切除子宫主、骶及膀胱宫颈韧带切缘的神经分布明显减少,说明SNSRH术中对于PAN的损伤小,达到保留PAN的目的。2.SNSRH和RH术后均导致膀胱功能发生不同程度的功能障碍,但是SNSRH较RH导致膀胱功能障碍的程度明显减轻。3.SNSRH不仅手术范围广,而且具有安全、可行、短期疗效好的特点。
[Abstract]:Objective: to study the safety, feasibility, effectiveness and significance of SNSRH and RH in preserving pelvic autonomic nerve and improving bladder function after operation by comparing the relevant indexes before, during, and after operation in patients with SNSRH and RH, and to explore the safety, feasibility and effectiveness of the clinical application of SNSRH. Thus providing a reliable theoretical basis for clinical practice, Methods: from January 2015 to February 2017, 60 patients with cervical cancer treated in gynecological ward of affiliated Hospital of Yan'an University were selected as prospective subjects. SNSRH group and RH group were divided into SNSRH group and RH group (n = 30). The average bleeding volume, mean operative time, the length of the main uterine ligament, sacral ligament and anterior and posterior wall of vagina were compared and analyzed in RH group and RH group. The number of re-indwelling urethral tubes, the pathological condition of the incisal margin, the distribution of the incised edge nerves of the hysterectomy, sacral and bladder cervical ligaments, and the preoperation, Microsoft Excel software was used to establish the database and SPSS 22.0 software package was used for statistical analysis. Results 1. The mean operation time of SNSRH group was compared with that of RH group. There was no significant difference in the mean blood loss, the length of the anterior and posterior wall of the uterus, sacral ligament and vagina, and the pathological condition of the incision margin between the SNSRH group and the RH group. 2. There was no significant difference between the SNSRH group and the RH group in the hysterectomy. There were significant differences in the distribution of nerves between sacral and bladder cervical ligament incised margin. 3. SNSRH group and RH group were compared in the frequency of re-indwelling urethral catheter and the relative parameters of urodynamic examination before and after operation. Conclusion: 1. The nerve distribution of sacral and bladder cervical ligament incised by RH is significantly reduced than that of RH, indicating that the injury to PAN in SNSRH is less than that in RH. 2. Both SNSRH and RH resulted in different degree of bladder dysfunction after operation. However, the degree of bladder dysfunction caused by SNSRH was significantly reduced than that of RH. 3. SNSRH not only had a wide range of operation, but also was safe and feasible. The characteristic of good short-term curative effect.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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