子宫颈癌广泛性子宫切除术后盆腔器官脱垂的初步研究  

Preliminary study of pelvic organ prolapse after radical hysterectomy for cervical cancer

作　　者：钟晓珠[1,2] 孙秀丽 王志启[1] 王悦[1] 梁旭东[1] 王建六[1] ZHONG Xiaozhu;SUN Xiuli;WANG Zhiqi;WANG Yue;LIANG Xudong;WANG Jianliu(Department of Obstetrics and Gynecology,Peking University People's Hospital,Beijing Key Laboratory of Female Pelvic Floor Disorders,Beijing 100044,China)

机构地区：[1]北京大学人民医院妇产科,北京市女性盆底疾病研究重点实验室,100044 [2]中山大学孙逸仙纪念医院妇产科

出　　处：《中国妇产科临床杂志》2019年第6期494-497,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨广泛性子宫切除术(radical hysterectomy,RH)后盆腔器官脱垂(pelvic organ prolapse,POP)的发生情况及相关影响因素。方法选择2013年1月至2016年1月在北京大学人民医院接受广泛性全子宫+双附件+盆腔淋巴结切除术2年以上的子宫颈癌患者(RH组)13例,采用POP定量分度(pelvic organ prolapse quantitation,POP-Q)法对各指示点进行测量并对脱垂程度进行分期,并与同期12例接受广泛性全子宫+双附件+盆腔淋巴结切除术+术后放疗的子宫颈癌患者(radiotherapy after radical hysterectomy,RH+RT组)和11例接受全子宫+双附件+盆腔及腹主动脉旁淋巴结切除术的子宫内膜癌患者(total hysterectomy,TH组)进行比较。结果TH组、RH组、RH+RT组的阴道总长度(total vaginal length,TVL)的中位数和四分位数分别为5.0cm(4.5 cm,6.0 cm)、4.0 cm(3.2 cm,5.0 cm)和3.0 cm(2.6 cm,3.5 cm),三组比较,差异均有统计学意义(P<0.05)。TH组患者C点的位置较RH组和RH+RT组均高(P<0.05)。RH组患者Aa点的位置较RH+RT组低[-2.5cm(-2.9 cm,-2.0 cm)和-3.0 cm(-3.0 cm,-2.7 cm),P=0.013],Ba点的位置较RH+RT组低[-2.5 cm(-2.9 cm,-2.0 cm)和-3.0 cm(-3.0 cm,-2.7 cm),P=0.012]。RH组较RH+RT组更容易发生阴道前壁脱垂(6/13和0/12,P=0.015),TH组较RH+RT组更容易发生阴道前壁脱垂(5/11和0/12,P=0.014)。结论与全子宫切除术相比,广泛性子宫切除术不显著增加术后盆腔器官脱垂的发生率,放疗可降低盆腔器官脱垂的发生率。Objective To investigate the occurrence and related factors of pelvic organ prolapse(POP)in patients after radical hysterectomy.Methods This retrospective cohort study included 36 patients who received surgery from January 2013 to January 2016.13 patients undergone radical hysterectomy and bilateral salping-oophenrectomy with lymphadenectomy(RH group),12 patients undergone radiotherapy after radical hysterectomy and bilateral salpingoophenrectomy with lymphadenectomy(RH+RT group)and 11 patients undergone total hysterectomy and bilateral salping-oophenrectomy with lymphadenectomy(TH group)to serve as the control group.The pelvic organ prolapse quantitation(POP-Q)system was used as the assessment tool.Results The average total vaginal length(TVL)of TH group,RH group,RH+RT group were 5.0(4.5,6.0)cm,4.0(3.2,5.0)cm and 3.0(2.6,3.5)cm(P<0.05).Comparison of the three groups showed statistically significant differences(P<0.05).The position of C point in TH group was higher than that in RH group and RH+RT group(P<0.05).The position of Aa[-2.5 cm(-2.9 cm,-2.0 cm)and-3.0 cm(-3.0 cm,-2.7 cm),P=0.013]and Ba point[-2.5 cm(-2.9 cm,-2.0 cm)and-3.0 cm(-3.0 cm,-2.7 cm),P=0.012]in RH group was lower than that in RH+RT group.The incidence of vaginal anterior prolapse in RH group(6/13,0/12,P=0.015)and TH group(5/11,0/12,P=0.014)was higher than that in RH+RT group.Conclusions Radical hysterectomy has little effect on the incidence of postoperative prolapse.Radiotherapy can reduce the incidence of POP after hysterectomy.

关 键 词：广泛性子宫切除术 辅助放疗 脱垂 POP-Q分期 

分 类 号：R73[医药卫生—肿瘤]