Bogani Giorgio, Serati Maurizio, Nappi Rossella, Cromi Antonella, di Naro Edoardo, Ghezzi Fabio
Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
J Sex Med. 2014 Dec;11(12):3012-20. doi: 10.1111/jsm.12702. Epub 2014 Sep 21.
Although growing evidence suggests the beneficial effects of a nerve-sparing (NS) approach to surgery in cervical cancer patients, only limited data on NS laparoscopic radical hysterectomy (LRH) are available, and no studies have investigated the effects of NS-LRH on sexual function.
This study aims to determine whether the implementation of NS-LRH impacts on sexual function in cervical cancer patients.
Sexually active cervical cancer patients undergoing type C (class III) LRH between 2004 and 2013 were enrolled in this prospective study.
Preoperative and postoperative sexual function were assessed using a validated questionnaire, the Female Sexual Function Index (FSFI). The FSFI evaluates desire, arousal, lubrication, orgasm, satisfaction, and pain.
Forty patients undergoing radical hysterectomy (20 conventional LRH vs. 20 NS-LRH) represented the study group. Baseline characteristics were similar between groups (P > 0.05). No differences in preoperative FSFI scores were recorded (P > 0.05). We observed that both LRH and NS-LRH worsened postoperative FSFI scores (P < 0.001). However, patients undergoing NS-LRH had higher postoperative FSFI scores than patients undergoing LRH (21.3 ± 9.4 vs. 14.2 ± 12.5; P = 0.04). Considering postoperative domain scores, we observed that desire, arousal, orgasm, and pain scores were similar between groups (P > 0.05), while patients undergoing NS-LRH experienced higher lubrication (3.4 ± 2.3 vs. 1.7 ± 2.2; P = 0.02) and satisfaction (4.6 ± 3.9 vs. 2.8 ± 2.2; P = 0.004) scores in comparison with patients undergoing conventional LRH. No between-group differences in survival outcomes were found.
Both conventional LRH and NS-LRH impact negatively on patients' sexual function. However, the NS approach impairs sexual function less, minimizing the effects of radical surgery.
尽管越来越多的证据表明保留神经（NS）的手术方法对宫颈癌患者有益，但关于保留神经的腹腔镜根治性子宫切除术（LRH）的数据有限，且尚无研究探讨保留神经的腹腔镜根治性子宫切除术对性功能的影响。
本研究旨在确定实施保留神经的腹腔镜根治性子宫切除术是否会影响宫颈癌患者的性功能。
本前瞻性研究纳入了2004年至2013年间接受C型（III级）腹腔镜根治性子宫切除术且有性生活的宫颈癌患者。
使用经过验证的女性性功能指数（FSFI）问卷评估术前和术后的性功能。FSFI评估性欲、性唤起、润滑、性高潮、满意度和疼痛。
40例行根治性子宫切除术的患者（20例行传统腹腔镜根治性子宫切除术，20例行保留神经的腹腔镜根治性子宫切除术）构成研究组。两组间基线特征相似（P>0.05）。术前FSFI评分无差异（P>0.05）。我们观察到，传统腹腔镜根治性子宫切除术和保留神经的腹腔镜根治性子宫切除术均使术后FSFI评分恶化（P<0.001）。然而，接受保留神经的腹腔镜根治性子宫切除术的患者术后FSFI评分高于接受传统腹腔镜根治性子宫切除术的患者（21.3±9.4 vs. 14.2±12.5；P=0.04）。考虑术后各领域评分，我们观察到两组间性欲、性唤起、性高潮和疼痛评分相似（P>0.05），而与接受传统腹腔镜根治性子宫切除术的患者相比，接受保留神经的腹腔镜根治性子宫切除术的患者润滑（3.4±2.3 vs. 1.7±2.2；P=0.02）和满意度（4.6±3.9 vs. 2.8±2.2；P=0.004）评分更高。未发现两组间生存结局存在差异。
传统腹腔镜根治性子宫切除术和保留神经的腹腔镜根治性子宫切除术均对患者性功能产生负面影响。然而，保留神经的手术方法对性功能的损害较小，可将根治性手术的影响降至最低。
