宫颈癌术后对患者盆底功能影响的研究

Effect of cervical cancer surgery on pelvic floor function

摘要:

目的 了解宫颈癌患者术后排尿功能、排便功能及性功能障碍的发生情况及盆底功能指标检测。方法 选取2014 年1 月-2016 年6 月广州医科大学第三附属医院宫颈癌行广泛全子宫切除（研究组）及子宫良性病变行全子宫切除（对照组）患者。其中，研究组40 例，对照组40 例。术后进行盆底功能检测，包括自由尿流率、残余尿、盆底电生理功能、神经损伤测定及生活质量问卷等，对两组进行统计学分析。结果 研究组和对照组患者术后6 个月膀胱功能障碍的发生率分别为35.0% 和5.0%，差异有统计学意义（P <0.05）；肠道功能障碍的发生率分别为16.3% 和10%，差异无统计学意义（P >0.05）；性功能障碍的发生率分别为56.7% 和20.0%，差异有统计学意义（P <0.05）；两组患者术后盆底功能障碍问卷（PFDI-20）、尿失禁性功能问卷（PISQ-12）评分比较，差异有统计学意义（P <0.05）；两组患者术后最大尿流率、平均尿流率、残余尿量、是否腹压排尿以及神经损伤比较，差异有统计学意义（P <0.05）；两组患者Ⅰ类肌纤维肌力比较差异有统计学意义（P <0.05），Ⅱ类肌纤维肌力比较差异无统计学意义（P >0.05）。结论 宫颈癌广泛子宫切除术后患者盆底功能障碍和生活质量下降发生率以及腹压排尿、盆底Ⅰ类肌纤维肌力下降、神经损伤发生率高于全子宫切除术后。

Abstract:

Objectives To investigate the effect of cervical cancer surgery on postoperative pelvic floor functional including micturition function, defecation function and sexual dysfunction. Methods A total of 40 cases of cervical cancer patients (study group) and 40 cases of uterine benign patients (control group) who were admitted into the third affiliated hospital of Guangzhou medical university from January 2014 to June 2016 received hysteretomy and were collected into this study. Pelvic floor functions such as free urine flow rate, residual urine, pelvic floor electrical physiological function, nerve damage and quality of life were recorded for further analysis. Results The incidence of postoperative bladder dysfunction in study group increased dramatically when compared with control group (35.0% vs 5.0%, P < 0.05). The incidence of intestinal dysfunction in study and control group were not statistically different (16.3% vs 10%, P > 0.05). The incidence of sexual dysfunction in study enhanced significantly when compared with control group (56.7% vs 20%, P < 0.05). The postoperative PFDI-20 and PISQ-12 questionnaire analysis further confirmed the above findings (P < 0.05). Record of postoperative maximum urinary flow rate, average urine flow rate, residual urine volume, whether to use abdominal pressure mediated urination and nerve damage suggested that patients in study group experienced worse when compared with control group(P < 0.05). Type muscle fiber strength was significantly worse in study group when compared with control group(P < 0.05), while no difference in type muscle fiber strength was observed (P > 0.05). Conclusions Incidence of pelvic floor dysfunction, lower quality of life, abdominal pressure mediated urination, decrease of type muscle fiber strength and nerve damage caused by radical hysterectomy are higher compared with hysteretomy.