【作者】 杨艳；

【导师】 郭钰珍；

【作者基本信息】 兰州大学 ， 临床医学/妇产科学（专业学位）， 2020， 硕士

【摘要】 目的:探讨因早期宫颈癌患者行腹腔镜下广泛子宫切除术(laparoscopic radical hysterectomy,LRH)术后3个月发生盆底功能障碍性疾病(pelvic floor dysfunction,PFD)的情况。通过妇科检查,盆底肌力测试评估,盆底功能障碍问卷调查(pelvic floor distress inventory-short from 20,PFDI-20)等诊断、评估患者术后盆底功能情况,为临床工作提供依据。方法:选取2018年12月-2019年12月就诊于兰州大学第二医院妇科因早期宫颈癌(按照国际妇产科联盟(FIGO)临床分期为IB1期及IIA1期)行腹腔镜下广泛子宫切除术的患者30例(术前所有患者均未行新辅助化疗,术后均未行放化疗)为研究组(LRH组);因妇科良性疾病(包括子宫平滑肌瘤、子宫腺肌瘤、难治性功能失调性子宫出血、子宫内膜息肉、子宫腺肌症等)行腹腔镜下全子宫切除术的患者30例为对照组(LH组),两组分别于术后3个月行妇科检查(包括阴道前后壁脱垂的分度及评估,阴道前穹窿膨出程度的诊断,以及直肠膨出的检查及评估;尿失禁发生的类型及严重程度的评估等);盆底肌力测试(包括快肌(II类肌纤维)阶段最大值,慢肌(I类肌纤维)阶段平均值及变异值,肌力评估总分);盆底功能障碍问卷调查PFDI-20等来判断两组患者术后3个月发生盆底功能障碍性疾病的类型及严重程度。结果:1.术后3个月妇科检查结果为:LRH组发生PFD的病例共29例(发生率为96.67%),LH组发生PFD的患者例数共25例(发生率为83.33%)。两组发生盆腔脏器脱垂(pelvic organ prolapse,POP)的病例LRH组共20例,LH组共5例,两组术后发生POP的病例中阴道前壁膨出发生率比较,差异具有统计学意义(P﹤0.05),但阴道前壁膨出程度差异无统计学意义(P>0.05);两组阴道后壁膨出发生率比较,差异具有统计学意义(P﹤0.05);阴道穹窿脱垂、直肠膨出等发生率无统计学差异(P>0.05)。两组发生尿失禁的病例LRH组共9例,LH组共20例,其中两组病例中压力性尿失禁(stress urinary incontinence,SUI)发生率比较,差异具有统计学意义(P﹤0.05);但压力性尿失禁的程度的发生率比较,差异无统计学意义(P>0.05);急迫性尿失禁、混合型尿失禁等发生率无统计学差异(P>0.05)。2.术后3个月盆底肌电测试结果:LRH组术后3个月快肌阶段(II类肌纤维)最大值平均值为(61.82±6.98)μV,慢肌阶段(I类肌纤维)平均值为(27.83±5.47)μV,慢肌阶段变异值平均值为(0.41±0.15);LH组术后3个月快肌阶段最大值为(55.15±11.19)μV,慢肌阶段平均值为(31.87±6.69)μV,慢肌阶段变异值平均值为(0.32±0.10);两组患者术后3个月快肌阶段最大值(P值0.007)、慢肌阶段平均值(P值0.014)、慢肌阶段变异值(P值0.010)差异均具有统计学差异(P﹤0.05)。3.术后3个月盆底功能障碍问卷调查PFDI-20结果:LRH组术后3个月PFDI-20平均得分为(14.37±4.40)分,LH组术后3个月PFDI-20平均得分为(15.90±4.63)分,两组患者术后盆底功能障碍问卷调查即PFDI-20得分比较,差异无统计学意义(P>0.05))。结论:1.行腹腔镜下广泛子宫切除术(LRH)的患者相比于行腹腔镜下全子宫切除术(LH)的患者,术后3个月更易发生盆底功能障碍性疾病;其中最多见的是盆腔脏器脱垂,尤其是阴道前后壁膨出。2.腹腔镜下广泛子宫切除术(LRH)术后3个月盆底肌力测试结果对应的发生盆底功能障碍性疾病的类型与术后行妇科检查诊断的盆底功能障碍性疾病的类型相一致。3.腹腔镜下广泛子宫切除术(LRH)术后3个月行妇科检查、盆底肌力测试联合PFDI-20盆底功能障碍问卷调查综合评估判断,可以更准确地诊断术后发生盆底功能障碍性疾病的情况,可在临床广泛推广应用。更多还原

【Abstract】 Objective : To investigate because of early cervical cancer patients with laparoscopic radical hysterectomy,LRH)3 months after pelvic floor functional disorder(pelvic floor dysfunction,PFD)situation(including department of gynaecology,pelvic floor muscle testing evaluation,pelvic floor dysfunction questionnaire(pelvic floor distress inventory-short from 20,PFDI-20),etc.).To discuss widely because of early cervical cancer with laparoscopic radical hysterectomy,LRH.)for patients with the effect of pelvic floor functional and postoperative pelvic floor functional disorder,provide the basis for clinical work.Methods: A total of 30 patients(no neoadjuvant chemotherapy before surgery,no chemoradiotherapy after surgery)who underwent laparoscopic radical hysterectomy for cervical cancer(stage IB1 and stage IIA1 according to the International Federation of Gynecology and Obstetrics)in the department of Gynecology of the second hospital of Lanzhou university from December 2018 to December 2019 were selected as the study group;the control group included 30 patients who underwent total laparoscopic hysterectomy for benign gynecological diseases(including myoma of uterus fibroid,endometrioma,refractory dysfunctional uterine bleeding,endometrial polyps,etc.),the two group underwent gynecological examinations(including the grading and evaluation of anterior and posterior wall prolapse,the examination and evaluation of anterior fornix and rectocele,the type and severity of urinary incontinence,etc.)three months after the operation,pelvic floor muscle strength test(including maximum value of fast muscle(type II muscle fiber),mean value and variation value of slow muscle(type I muscle fiber),total score of muscle strength assessment),pelvic floor function questionnaire,etc.)were used to evaluate the pelvic floor function of patients three months after surgery.Results:1.The results of gynecological examination 3 months after the operationwere as follows: there were 29 cases of pelvic floor dysfunction(PFD)in the LRH group(the incidence was 96.67%),and 25 cases of pelvic floor dysfunction(the incidence was 83.33%)in the LH group.Two groups of pelvic organ prolapse(pelvic outraged prolapse,POP)cases of LRH group a total of 20 cases,LH group a total of 5cases,two groups of postoperative pelvic organ prolapse comparative incidence of cases before the vaginal wall surfaces,difference have statistical significance(P ﹤0.05),but there was no statistically significant difference degree of vaginal bulging anterior wall(P > 0.05);The incidence of posterior wall extrudation in the two groups was statistically significant(P < 0.05).There was no statistical difference in the incidence of vaginal vault prolapse and rectal swelling(P > 0.05).There were 9 cases of urinary incontinence in the LRH group and 20 cases in the LH group.There was a statistically significant difference in the incidence of stress urinary incontinence(SUI)in the two groups(P < 0.05).However,there was no statistically significant difference in the incidence of stress incontinence(P > 0.05).There was no statistical difference in the incidence of urgency incontinence and mixed incontinence(P > 0.05).2.Results of pelvic floor muscle test 3 months after the operation: the maximum value of fast muscle stage in the LRH group was(61.82±6.98)μV,the mean value of slow muscle stage was(27.83±5.47)μV,,and the mean variation value of slow muscle stage was(0.41±0.15).Three months after the operation,the maximum value of fast muscle stage in LH group was(55.15±11.19)μV,,the mean value of slow muscle stage was(31.87±6.69)μV,,and the mean variation value of slow muscle stage was(0.32±0.10).The maximum value of fast muscle stage(P value 0.007),the mean value of slow muscle stage(P value 0.014),and the variation value of slow muscle stage(P value 0.010)in the two groups 3 months after the operation showed statistical differences(P < 0.05).3.PFDI-20 results of the questionnaire survey on pelvic floor dysfunction 3months after the operation: the average score of pfdi-20 in the LRH group was(14.37±4.40)3 months after the operation,and the average score of pfdi-20 in the LH group was(15.90±4.63)3 months after the operation.Conclusion: 1.Patients undergoing laparoscopic radical hysterectomy(LRH)are more likely to develop pelvic floor dysfunction 3 months after surgery than patients undergoing laparoscopic total hysterectomy(LH).What sees most among them is pelvic viscera prolapse,especially before and after vaginal wall bulges.2.The types of pelvic floor dysfunction diseases corresponding to the results ofpelvic floor muscle strength test 3 months after laparoscopic radical hysterectomy(LRH)were consistent with the types of pelvic floor dysfunction diseases diagnosed by gynecological examination.3.3 months after laparoscopic radical hysterectomy(LRH),gynecological examination and pelvic floor muscle strength test combined with PFDI-20 questionnaire survey on pelvic floor dysfunction can more accurately diagnose the postoperative pelvic floor dysfunction,which can be widely used in clinical practice.更多还原