广泛全子宫切除术联合盆腔淋巴结清扫术治疗宫颈癌的效果及术后盆底功能障碍性疾病的影响因素分析  

An Analysis of the Effect of Extensive Hysterectomy Combined with Pelvic Lymphadenectomy on Cervical Cancer and the Influencing Factors of Postoperative Pelvic Floor Dysfunction

作　　者：李媛媛[1] 杨大平[1] 孙艳艳 LI Yuanyuan;YANG Daping;SUN Yanyan(Suzhou Municipal Hospital, Anhui Suzhou 234000, China)

机构地区：[1]安徽省宿州市立医院妇科,安徽宿州234000

出　　处：《河北医学》2020年第8期1347-1352,共6页Hebei Medicine

基　　金：安徽省自然科学基金项目,(编号:1608062MH129)。

摘　　要：目的:探讨广泛全子宫切除术联合盆腔淋巴结清扫术治疗宫颈癌的效果,并分析患者术后盆底功能障碍性疾病(PFD)的影响因素。方法:选取2015年1月至2019年6月在我院治疗的宫颈癌患者63例,按照随机数表法分为研究组(32例)和对照组(31例),均采用广泛全子宫切除术联合盆腔淋巴结清扫术治疗,研究组采取腹腔镜,对照组采取常规开腹。比较两组患者术中及术后情况、并发症发生情况,采用二项Logistic回归分析术后PFD的危险因素。结果:研究组的手术时间、术中出血量、第一次下床时间、肛门排气时间、术后排便时间、住院时间明显低于对照组,研究组的淋巴结清扫数目明显高于对照组,差异有统计学意义(P<0.05)。研究的并发症发生率为56.25%,明显低于对照组的87.10%,差异有统计学意义(P<0.05)。术后发生PFD共38例,经单因素分析,年龄、肿瘤直径、有无绝经、留置尿管时间为宫颈癌患者术后发生PFD的影响因素(P<0.05);经多因素二元Logistic分析,年龄≥45岁、肿瘤直径≥4cm、已绝经、留置尿管时间≥7d为宫颈癌患者术后发生PFD危险因素(P<0.05)。结论:腹腔镜下广泛全子宫切除术联合盆腔淋巴结清扫术治疗宫颈癌患者效果良好,但术后发生PFD较高,应对年龄、肿瘤直径偏大,已绝经,留置尿管时间过长的患者采取相应措施。Objective:To investigate the effect of extensive hysterectomy combined with pelvic lymphadenectomy for cervical cancer,and to analyze the influencing factors of postoperative pelvic floor dysfunction(PFD).Methods:63 patients with cervical cancer who were treated in our hospital from January 2015 to June 2019 were divided into study group(32 cases)and control group(31 cases)with random table method.All patients underwent extensive hysterectomy combined with pelvic lymphadenectomy.As to reatment,the study group took laparoscopy,and the control group took conventional open surgery.The intraoperative and postoperative conditions and complications were compared between the two groups.Binary logistic regression was used to analyze the risk factors of postoperative PFD.Results:The operation time,intraoperative blood loss,time to get out of bed,anal exhaust time,postoperative defecation time,and hospitalization time of the study group were significantly lower than those of the control group.The number of lymph node dissection in the study group was significantly higher than that of the control group.It is tatistical significance(P<0.05).The complication rate of the study was 56.25%,which was significantly lower than that of the control group(87.10%).The difference was statistically significant(P<0.05).A total of 38 cases of PFD occurred after operation.The factors of age,tumor diameter,presence or absence of ejaculation,and indwelling catheter were the influencing factors of postoperative PFD in patients with cervical cancer(P<0.05).Multivariate binary logistic analysis reveals that age≥45 years,tumor diameter≥4cm,menopausal,urethral catheter indwelling time≥7d were risk factors for postoperative PFD in patients with cervical cancer(P<0.05).Conclusion:Laparoscopic extensive hysterectomy combined with pelvic lymphadenectomy for cervical cancer patients has a good effect,but incidence rate of postoperative PFD is high.Proper measures should be taken to aged menopausal patients whose tumor diameter is too large,and ur

关 键 词：广泛全子宫切除术 盆腔淋巴结清扫术 腹腔镜 宫颈癌 术后盆底功能障碍性疾病 影响因素 

分 类 号：R73[医药卫生—肿瘤]