保留神经的全子宫切除术对绝经前后妇女排尿排便功能的影响  

Impact of nerve-sparing hysterectomy on urinating and bowel function in premenopausal or postmenopausal women

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作  者:陈丽平[1] 刘曼华[1] 王芳[1] 刘宏斌[2] 

机构地区:[1]南通大学第二附属医院妇产科,江苏南通226001 [2]南通大学第二附属医院病理科,江苏南通226001

出  处:《南京医科大学学报(自然科学版)》2012年第12期1714-1719,共6页Journal of Nanjing Medical University(Natural Sciences)

基  金:南通市社会发展科技项目(S2010037)

摘  要:目的:通过与传统全子宫切除术的比较,探讨保留神经的改良全子宫切除术对绝经前、后妇女排尿、排便功能的影响。方法:选择150例实施保留神经的改良手术的患者为研究对象,并以另150例实施传统全子宫切除术的患者为对照。于两组切除的子宫标本上分别取主韧带、骶韧带、膀胱宫颈韧带的切缘行S-100抗体的测定;根据患者是否绝经及绝经年限在两组内均分为绝经前期组、绝经早期组及绝经晚期组,分别比较术后1个月、1年的排尿及排便功能情况。结果:改良手术组的3组韧带切缘S-100阳性区域所占的面积比例均显著低于传统手术组;两组患者的手术时间、术中出血量及术后住院日比较无显著差异(P均>0.05);改良手术组患者术后1个月、1年的尿频、排尿等待、尿失禁以及便秘发生率均低于传统组;其中绝经前、绝经早期的两组患者比较,除绝经早期患者术后1个月尿频、排尿等待的发生率有统计学意义,其余均无统计学意义(P>0.05),而绝经晚期的患者改良手术组术后1个月、1年的尿频、排尿等待以及便秘发生率与传统手术组相比较均有显著差异。结论:改良子宫切除术较传统手术能减少支配膀胱直肠神经的损伤,降低患者术后尿频、排尿等待以及便秘的发生率,对绝经晚期的老年患者效果尤为显著。Objective:To explore the effect on the urination and bowel function of nerve-sparing modified hysterectomy and traditional hysterectomy in pre-menopausal or postmenopausal women.Methods:In total,150 cases were treated by the nerve-sparing modified hysterectomy(study group),and 150 cases were treated by traditional abdominal hysterectomy(control group).All uterine samples with cardinal ligament,sacral ligament,vesicocervical ligament were obtained.Expressions of S-100 in those attached ligaments were evaluated by immunohistochemistry technique in order to investigate the contents of nerves.According to whether the patient in premenopausal and menopausal period,the two groups were divided into three parts:premenopausal patients,early menopausal patients(menopausal period was no more than 5 years),late menopausal patients(menopausal period was more than 5 years).Their urination and defecation in one month and one year after operation were compared.Results:Contents of nerves in ligament stump of the study group were significantly lower than those of controls.There was no significant difference in operative time,intra-operative blood loss and length of postoperative hospital stay between the two groups.The incidence rates of frequent micturition,delay of urination,urinary incontinence and constipation in the study group were lower than those in the control group in one month and one year.Compared between the two groups,there was no statistically significance in pre-menopausal,early menopausal patients(P 0.05),except the incidence rate of frequent urination,and delay of urination in one month in early menopausal patients.But in the late menopausal patients,the incidence rates of frequent urination,delay of urination and constipation in the study group were significantly different from those in the control group in one month and one year.Conclusion:Compared with the traditional hysterectomy,reformed operation can reduce the damage of disposable bladder and bowel nerve and depress the incide

关 键 词:子宫切除术 保留神经 S-100蛋白 绝经 排尿排便功能 

分 类 号:R713.42[医药卫生—妇产科学]

 

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