改良盆腔腹膜缝合法在延长宫颈癌术后阴道长度的效果及评价

发布时间：2018-08-30 18:13

【摘要】：背景与目的宫颈癌是女性生殖系统最常见的恶性肿瘤,随着筛查技术的提高及普及,宫颈癌发病率逐年上升,且呈现明显的年轻化趋势。多数早期患者接受宫颈癌根治手术后能长期生存。宫颈癌根治术的标准术式是根治性子宫切除+盆腔淋巴结清扫术,该术式的范围比较大,术后可能会出现一些明显不适,如阴道明显缩短,患者提前出现更年期症状等,这些均可能影响患者的生活质量,尤其是年轻患者表现的更加明显。近几年我院最常使用的手术方式是腹腔镜下宫颈癌根治术,为了寻求上述不适的解决办法,临床医生不断探索尝试卵巢移位术和阴道延长术,并不断改进手术方式。现今临床常采用腹膜代阴道延长术,但其手术方法比较复杂,且临床效果欠满意,所以,临床工作者需要不断探索,寻找简便、易行、有效的方法来延长宫颈癌术后阴道长度。本研究的目的:探讨改良盆腔腹膜缝合法对延长宫颈癌根治术后阴道长度及改善性生活的效果及可行性。临床资料与方法2012年1月至2014年6月在我院行腹腔镜下广泛全子宫切除+盆腔淋巴结清扫术的52例患者为研究对象,患者年龄26~41岁,中位年龄38岁,均为宫颈鳞状细胞癌;临床分期(FIGO,2009)IB1期38例、IB 2期9例、IIA期5例;术前行新辅助化疗4例,腔内半量放疗3人,未经任何治疗45人;其中2013年以前27例患者行传统盆腔腹膜缝合(对照组),自2014年起25例行改良盆腔腹膜缝合(研究组);两组在年龄、病理类型、临床分期、术前治疗情况等方面具有可比性,两组患者均行卵巢移位术。将两组实验对象的术中情况、术后阴道长度及性生活恢复情况进行对比。计量资料用“均数±标准差”来表示,计数资料用百分比来表示。统计学方法采用χ2检验、t检验,重复测量数据的方差分析等。设α=0.05为检验水准,P0.05为差异有统计学意义,所有统计学数据均应用SPSS 17.0统计软件包进行分析。结果1术中情况两组手术均顺利完成,术中均未明显损伤脏器,统计学数据表明,两组在手术时间、术中出血量方面无统计学差异(P0.05)。2术后情况两组在术后肛门排气时间、导尿管保留时间、术后病率、术后淋巴潴留囊肿发生率方面均无统计学差异(P0.05)3阴道长度整个研究过程中,需要测量患者阴道长度4次,分别是术前、术后3月、6月、12月。两组患者术后1个月复查各有5例阴道残端轻度炎性反应,术后3个月行妇科检查、TCT涂片无异常,阴道残端愈合良好。术后3、6、12个月门诊复查,研究组分别为(8.88±0.97)cm、(9.00±1.00)cm、(9.08±0.86)cm,对照组分别为(5.89±0.89)cm、(5.93±0.96)cm、(5.78±1.09)cm,采用重复测量数据的方差分析,不同时间段研究组平均阴道长度均长于对照组,差异有统计学意义(P0.05)。4性生活质量术后对患者进行随访,随访期间无复发或者死亡病例。所有患者于术后3~6个月开始恢复性生活。本研究采用女性性功能量表(详见附录)对两组患者术后12个月性功能进行测评,分析数据显示,研究组在性满意、性疼痛、性高潮方面均明显优于对照组(P0.05),而在性润滑、性渴望、性唤起方面二组差异均无统计学意义(P0.05)。结论对年轻宫颈癌患者施行宫颈癌根治术时选用改良盆腔腹膜缝合法,能有效延长术后阴道长度,改善术后性生活质量,不增加手术难度和手术时间,简单易行,安全有效,值得临床推广应用。
[Abstract]:BACKGROUND & OBJECTIVE Cervical cancer is the most common malignant tumor of the female reproductive system. With the development and popularization of screening techniques, the incidence of cervical cancer is increasing year by year, and it shows an obvious younger trend. Laparoscopic cervical lymphadenectomy may cause some obvious discomfort, such as vaginal shortening and premature menopausal symptoms, which may affect the quality of life of patients, especially in young patients. In recent years, laparoscopic cervical surgery is the most commonly used method in our hospital. In order to find a solution to the above-mentioned discomfort, clinicians continue to explore and try ovarian transposition and vaginal lengthening, and constantly improve the surgical methods. Objective: To investigate the effect and feasibility of modified pelvic peritoneal suture for prolonging vaginal length and improving sexual life after radical resection of cervical cancer. Fifty-two patients with cervical squamous cell carcinoma, ranging in age from 26 to 41 years and median age from 38 years, underwent palpation dissection; 38 patients with stage IB1, 9 patients with stage IB 2, and 5 patients with stage IIA were enrolled in clinical stage (FIGO, 2009); 4 patients received neoadjuvant chemotherapy, 3 patients received intracavitary half-dose radiotherapy, and 45 patients received conventional pelvic peritoneal therapy before 2013. Suture (control group), since 2014 25 cases of pelvic peritoneal suture (study group); two groups in age, pathological type, clinical staging, preoperative treatment and other aspects of comparability, two groups of patients with ovarian transposition surgery. The two groups of experimental subjects in the operation, postoperative vaginal length and sexual life recovery were compared. Statistical methods used_2 test, t test, analysis of variance of repeated measurements, etc. Set alpha = 0.05 as the test level, P 0.05 as the difference was statistically significant. All statistical data were analyzed by SPSS 17.0 statistical software package. There was no significant difference in operative time and bleeding volume between the two groups (P 0.05). 2 There was no significant difference in postoperative anal exhaust time, catheter retention time, postoperative morbidity and incidence of postoperative lymphatic retention cyst between the two groups (P 0.05). During the whole study, vaginal length was measured 4 times, preoperatively, 3 months, 6 months and 12 months after the operation. 5 cases of vaginal stump mild inflammatory reaction were examined one month after the operation in both groups. Gynecological examination was performed 3 months after the operation. TCT smear was normal and vaginal stump healed well. The mean vaginal length of the study group was longer than that of the control group at different time intervals (P 0.05). There was no significant difference (P 0.05). There was no significant difference (P 0.05). The mean vaginal length of the study group was longer than that of the control group at different time intervals. Recurrence or death. All patients resumed sexual life from 3 to 6 months after surgery. This study used the Female Sexual Function Scale (see appendix) to evaluate the sexual function of the two groups at 12 months after surgery. The analysis showed that the study group was significantly better than the control group in terms of sexual satisfaction, sexual pain, orgasm (P 0.05), and sexual lubrication, thirst. Conclusion Modified pelvic peritoneal suture can effectively prolong the length of vagina, improve the quality of sexual life, and not increase the difficulty of operation and operation time. It is simple, safe and effective, and worthy of clinical promotion. Use.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.33;R713

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