腹腔镜下保留盆腔神经的广泛性子宫切除术对术后膀胱功能恢复的影响  

Influence of laparoscopic nerve-sparing radical hysterectomy on the postoperative recovery of the bladder function

作　　者：朱芳芳[1] 申沛[1] 赵洪伟[1] 郭伟平[1] 张迎旭[1] 林耀蕙[1] 朱前勇[1] 

机构地区：[1]中国人民解放军第152中心医院妇产科,河南平顶山467000

出　　处：《中华实用诊断与治疗杂志》2014年第11期1107-1109,共3页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的探讨腹腔镜下保留盆腔神经的广泛性子宫切除术对早期宫颈癌术后膀胱功能的影响。方法 128例接受手术治疗的Ⅰa2~Ⅱa期宫颈癌患者分为观察组68例和对照组60例,观察组行腹腔镜下保留盆腔神经的广泛子宫切除术,对照组行腹腔镜下广泛性子宫切除术,比较2组手术时间、术中出血量、切除淋巴结数量、宫颈旁组织切除长度、阴道切除长度、术后拔除导尿管时间,2组均于术前、术后3个月、1a行尿动力学检查,2组于术前、术后3、6个月及1、2a采用尿失禁生活质量问卷（I-QOL）对患者术后排尿情况进行评分。结果 2组手术时间、术中出血量、切除淋巴结数量、宫颈旁组织切除长度和阴道切除长度比较差异均无统计学意义（P〉0.05）;观察组术后拔除导尿管时间（（8.6±3.1）d）明显短于对照组（（12.2±5.5）d）（P〈0.05）;观察组术后3个月、1a最大尿流率（（12.8±4.5）、（20.5±3.8）mL/s）、最大逼尿肌收缩力（（18.3±7.3）、（36.2±7.8）cm H2O）、膀胱顺应性（（35.0±5.0）、（82.0±46.0）mL/cm H2O）明显高于对照组（（8.7±3.1）、（14.6±3.7）mL/s,（10.1±6.8）、（28.5±8.2）cm H2O,（18.0±6.0）、（60.0±36.0）mL/cm H2O）,最大膀胱容量（（520.0±154.0）、（450.0±134.0）mL）明显低于对照组（（670.0±184.0）、（570.0±165.0）mL）（P〈0.05）;2组术后3个月、1a最大尿流率、最大逼尿肌收缩力、膀胱顺应性明显低于术前,术后3个月低于术后1a（P〈0.05）;最大膀胱容量明显高于术前,术后3个月高于术后1a（P〈0.05）;2组术后3、6个月I-QOL评分较术前下降（P〈0.05）,观察组术后3、6个月、1a时I-QOL评分（70.6±15.6、83.6±16.8、89.3±20.5）明显高于对照组（60.2±10.4、72.3±16.3、80.2±17.8）（P〈0.05）。结论腹腔镜下保留盆腔神经的广泛子宫切除术可有效改善早期宫颈癌患者术后膀胱功能,且安全可行�Objective To investigate the influence of laparoscopic nerve-sparing radical hysterectomy on the postoperative recovery of bladder function in patients with early cervical cancer.Methods A total of 128 patients with cervical cancer in stageⅠa2to Ⅱa were randomly divided into observation group（n=68）receiving laparoscopic nerve-sparing radical hysterectomy and control group（n=60）receiving laparoscopic radical hysterectomy.The operation lasting time,intraoperative blood loss,number of removed lymph nodes,extent of removed parametrium,the length of removed vagina,and postoperative catheter removal time were compared between two groups.Both two groups underwent urodynamic detection before,and 3 months and 1 year after operation.Incontinence Quality of Life（I-QOL）questionnaire was fulfilled by patients in both groups to investigate the urination status before,and 3months,6months,one year and two years after operation.Results No significant differences were observed in operation lasting time,intraoperative blood loss,number of removed lymph nodes,extent of removed parametrium and length of removed vagina between two groups（P〉0.05）.The mean time of catheter removed was（8.6±3.1）days in observation group,significantly shorter than that in control group（12.2±5.5）days（P〈0.05）.The maximum urinary flow rates（（12.8±4.5）,（20.5±3.8）mL/s）,maximum detrusor contractilities（（18.3±7.3）,（36.2±7.8）cm H2O）,bladder compliance（（35.0±5.0）,（82.0±46.0）mL/cm H2O）were significantly higher in observation group than those in control group in 3months and 1year after operation（（8.7±3.1）,（14.6±3.7）mL/s;（10.1±6.8）,（28.5±8.2）cm H2O;（18.0±6.0）,（60.0±36.0）mL/cm H2O）,and all the above indexes were significantly lower than those before operation,and were lower 3months after operation than those one year after operation（P〈0.05）.The maximum bladder capacities were（520.0±154.0）and（450.0±134.0）mL,significantly lower than those in c

关 键 词：宫颈癌 广泛性子宫切除术 腹腔镜 保留神经 膀胱功能 

分 类 号：R713.42[医药卫生—妇产科学]