宫颈周围韧带切除范围与术后近期膀胱功能障碍的相关性分析  

Short-Term Bladder Dysfunction after Surgery with the Different Extent of Resection of the Cervical Ligament

作　　者：陈春林[1] 莫可欣[1] 刘萍[1] 李维丽[1] 李峰娟[1] 黄劲松[1] 郭玉[1] 黄蕾[1] 苏桂栋[1] 龚时鹏[1] 王莉伶[1] 刘云鹭 王雪芹[1] 

机构地区：[1]南方医科大学南方医院,广东广州510515

出　　处：《实用妇产科杂志》2016年第12期902-906,共5页Journal of Practical Obstetrics and Gynecology

基　　金：科技部十二五国家科技支撑项目(编号:2014BAI05B03);广州市科技计划健康医疗协同创新重大专项(编号:201508020264);广东省科技计划项目(编号:2012B031800392)

摘　　要：目的:探讨宫颈周围韧带切除长度、宽度及阴道切除长度与术后近期膀胱功能障碍的相关性。方法:前瞻性研究2009年10月至2013年5月接受广泛性或次广泛性子宫切除术的宫颈癌或子宫内膜癌患者73例,术中测量切除标本的宫颈周围韧带切除长度、宽度及阴道前、后壁切除长度,术后记录留置尿管时间及最终残余尿量,术后3月接受下尿路及膀胱功能评估(MHU)量表调查及尿流动力学检查。并对宫颈周围韧带切除范围与术后近期膀胱功能障碍相关指标行Logistics回归单因素分析及多因素分析。结果:多因素分析示:1主观症状调查提示术后排尿困难、术后MHU量表评分与左侧阴道旁组织(PC)切除宽度呈正相关(P=0.008;P=0.028);2尿流动力学检查提示术后初始感觉膀胱容量与右侧PC切除宽度呈正相关(P=0.011),术后逼尿肌不稳定性与右侧骶子宫韧带(USL)切除宽度呈正相关(P=0.045)。结论:术后近期膀胱功能障碍的发生主要与术中USL及PC切除宽度相关,从而推测系统保留盆腔自主神经的广泛性子宫切除术的重点在于USL及PC的处理。Objective：To investigate the relationship between the extent of cervical ligament specimen and the resection length of vagina and the post-operative short-term urodynarnic bladder dysfunction. Methods：Between Oct 2009 and May 2013, mRH/RH was performed on 73 patients with cervical cancer or endometrial cancer. The extent,including length and width, of the excised portions of cardinal and uterosacral ligament and paracolpium complex and vagival cuff resection were measured during the operation. Recording the foley days and postvoid residual urine. ALL accepted MHU scale investigation and urodynamic at 3 months after radical hysterectomy. Logistics regression analysis and multivariate analysis were conducted to analyze the relationship between the extent of cervical ligament specimen and the resection length of vagina and the post-operative short-term urodynamic bladder dysfunction. Results：By multivariate analysis：（1）subjective symptoms survey demonstrated that dysuria and MHU scale score were positively correlated with the width of left paracolpium complex resection （ P = 0. 008;P = 0. 028）. （2）Urodynamics showed that volume at the first desire to void was positively correlated with the width of right paracolpium complex resection （ P = 0.011 ）, while the detrusor instability was positively correlated with the width of right uterosacral ligament resection （ P = 0.045）. Conclusions： The study finds that postoperative short-term urodynamic bladder dysfunction is significantly related to the width of USL resection and PC resection, thus surmise SNSRH should focus on the resection of USL and PC.

关 键 词：膀胱功能障碍 主韧带 骶子宫韧带 阴道旁组织复合体 

分 类 号：R713.4[医药卫生—妇产科学]