腹腔镜下保留盆腔自主神经广泛性子宫切除术对盆底功能的影响  

Effect of laparoscopic nerve-sparing radical hysterectomy on pelvic floor functions:report of 138 cervical cancer cases

作　　者：赵娜[1] 曹莉莉[1] 方露雪 徐惠成[1] 

机构地区：[1]第三军医大学西南医院妇产科,重庆400038

出　　处：《第三军医大学学报》2017年第7期691-695,共5页Journal of Third Military Medical University

摘　　要：目的分析比较腹腔镜下保留盆腔自主神经广泛性子宫切除术(laparoscopic nervesparing radical hysterectomy,LNSRH)及传统腹腔镜下广泛性子宫切除术(laparoscopic radical hysterectomy,LRH)两种术式宫颈癌患者术后盆底功能恢复情况,探讨LNSRH对患者盆底功能的影响。方法收集2012-2014年FIGO临床分期为Ⅰb1~Ⅱa2期、于我院接受LNSRH(观察组,n=138)和LRH(对照组,n=138)的宫颈癌患者的临床资料,进行回顾性队列研究,比较两组患者的手术时间、术中出血量、淋巴结切除数目、阴道壁切除长度、住院时间和并发症情况,观察两种手术对患者术后膀胱、直肠及生活质量的影响。结果患者均顺利完成手术,两组患者的手术时间、术中出血量、淋巴结切除数目、阴道壁切除长度、死亡率及复发率比较差异均无统计学意义(P>0.05);与LRH组比较,LNSRH组术后住院时间、肛门排气时间及排便时间均缩短,术后泌尿系统并发症(34.8%vs 71.0%)及消化系统并发症(21.7%vs 49.3%)均减少,差异有统计学意义(P<0.05);LNSRH组留置尿管天数主要集中在7~14 d,而LRH组主要集中在>15 d,差异有统计学意义(P<0.05);LNSRH组术后尿失禁生活质量问卷(incontinence quality of life questionnaire,I-QOL)及盆底障碍影响简易问卷7(pelvic floor impact questionnaire 7,PFIQ-7)评分均优于LRH组(P<0.05)。结论 LNSRH作为早期宫颈癌手术治疗方式,可保护患者术后膀胱、直肠等盆底器官功能,并在一定程度上提高患者术后生活质量。Objective To compare the pelvic floor functions in females undergoing laparoscopic nerve-sparing radical hysterectomy（LNSRH） and conventional laparoscopic radical hysterectomy（LRH） for cervical cancer,and determine the effect of LNSRH on the functions. Methods A retrospective cohort pilot study was carried out to compare the pelvic floor functions of the patients undergoing LNSRH（n = 138,treatment group） with those of LRH（n = 138,control group）. All these patients were in FIGO stage Ⅰb1 ~Ⅱa2 and underwent the surgeries in our department from January 2012 to December 2014. The operation time,blood loss,numbers of resected pelvic lymph nodes,length of vagina resection,length of hospital stay and incidence of complications were collected and compared between the 2 groups. The postoperative functions of bladder and rectum,and their quality of life were assessed. Results All the patients were performed successfully. No significant differences were observed in terms of mean operation time,blood loss,numbers of resected pelvic lymph nodes,length of vagina resection,mortality and recurrence rates between the 2 groups（P〈0. 05）. The length of hospital stay and durations for anal exhaust and defecation were shorter,and incidences of urinary（34. 8% vs 71. 0%） and digestive complications（21. 7% vs 49. 3%） were lower in the LNSRH group than the other group（P〈0. 05）. The former group also had notably shorter time of indwelling catheter（mainly 7 ~ 14 vs 15 d,P〈0. 05）,and higher postoperative scores of the Incontinence Quality of Life Questionnaire（I-QOL） and the Pelvic Floor Impact Questionnaire 7（PFIQ-7） when compared with the LRH group. Conclusion LNSRH is a sound approach in treatment of early-stage cervical cancer,which can protect postoperative pelvic floor functions（bladder and rectum）,and is helpful to improve the quality of life for the patients.

关 键 词：腹腔镜 保留神经 广泛性子宫切除术 宫颈癌 盆底功能 

分 类 号：R615[医药卫生—外科学] R730.7[医药卫生—临床医学]