Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Ambulatory Day Clinic Altonaer Strasse, Hamburg, Germany.
Arch Gynecol Obstet. 2018 Aug;298(2):337-344. doi: 10.1007/s00404-018-4812-7. Epub 2018 Jun 14.
To evaluate postoperative sexual functioning and the influence of patients' expectations on the change in sexuality following laparoscopic total (TLH) versus subtotal hysterectomy (LASH).
A total of 120 women undergoing laparoscopic hysterectomy were preoperatively enrolled in this bicentric prospective study. Sexual functioning (SF) was evaluated using the female sexual function index (FSFI). Additionally, participants filled in a standardised questionnaire concerning expected changes in SF after surgery. At 3, 6 and 12 months following surgery, women were asked again to assess their level of SF (FSFI). Data of women who participated in at least one FSFI follow-up assessment were analysed (n = 92). We compared the change in SF after surgery between patients with TLH (n = 46) and LASH (n = 46). Additionally, we calculated regression analyses with the patients' expectations as a predictor for change in FSFI scores.
Comparing the change of FSFI scores after surgery in both collectives revealed differences only 3 months after surgery, as improvement was stronger for the LASH collective compared to the THL group (p = 0.006). There were no changes comparing collectives after 6 (p = 0.663) and 12 (p = 0.326) months. Concerning patients' expectations, for the LASH group baseline SF (p < 0.001), but not expectations (p = 0.567) predicted the strength of change at each of the follow ups: a lower level of baseline SF was linked to a stronger improvement after surgery. For the THL collective, both baseline SF (p < 0.001) as well as patients' expectations (3 months: p = 0.077, 6 months: p = 0.37, 12 months: p = 0.024) predicted the strength of change: both, a lower level of baseline SF and higher expectations towards an improvement predicted a stronger improvement.
The preservation of the cervix does not show an advantage in improving SF after surgery. Both methods induce a comparable improvement in long-time SF, especially in patients with an impaired sexuality pre-surgery. Furthermore, patients' expectations concerning this matter seem to have an impact on the postoperative outcome; therefore, this circumstance should be considered in future projects.
评估腹腔镜全子宫切除术（TLH）与次全子宫切除术（LASH）术后的性功能变化，以及患者预期对术后性生活变化的影响。
本研究共纳入 120 例行腹腔镜子宫切除术的女性患者，采用女性性功能指数（FSFI）评估术前和术后的性功能。此外，患者还填写了一份关于术后预期性功能变化的标准化问卷。术后 3、6 和 12 个月，再次评估女性的性功能水平（FSFI）。对至少进行一次 FSFI 随访评估的女性患者（n=92）进行数据分析。我们比较了 TLH 组（n=46）和 LASH 组（n=46）术后性功能的变化。此外，我们还进行了回归分析，将患者的预期作为 FSFI 评分变化的预测因素。
比较两组术后 FSFI 评分的变化，仅在术后 3 个月时发现差异，LASH 组的改善明显强于 TLH 组（p=0.006）。术后 6 个月（p=0.663）和 12 个月（p=0.326）时两组间无变化。关于患者的预期，LASH 组基线性功能（p<0.001），而不是预期（p=0.567），预测了每次随访的变化强度：基线性功能越低，术后改善越强。对于 TLH 组，基线性功能（p<0.001）以及患者的预期（3 个月：p=0.077，6 个月：p=0.37，12 个月：p=0.024）均预测了变化的强度：基线性功能较低和对改善的较高预期均预示着术后改善更明显。
保留宫颈并不能改善术后性功能。两种方法在长期性功能方面都能产生相似的改善，尤其是对术前性功能受损的患者。此外，患者对这方面的预期似乎对术后结果有影响，因此，在未来的项目中应考虑这一因素。
