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腹腔镜保留神经根治性子宫切除术对膀胱功能恢复的影响。

Effect of Laparoscopic Nerve-Sparing Radical Hysterectomy on Bladder Function Recovery.

作者信息

Liu Qing, Li Peiquan, Sun Yuxin, Zhang Shu, Liu Kaijiang

机构信息

Department of Gynaecological Oncology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, People's Republic of China.

Department of Gynecology and Obstetrics, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, People's Republic of China.

出版信息

J Invest Surg. 2020 Apr;33(4):381-386. doi: 10.1080/08941939.2018.1502377. Epub 2018 Oct 31.

Abstract

: Radical hysterectomy could result in dysfunctions of pelvic organs and a decline in quality of life. : 298 patients who had underwent laparoscopic radical hysterectomy were retrospectively analyzed in this study, of which 216 patients had underwent laparoscopic nerve-sparing radical hysterectomy (LNSRH) and 82 had underwent classical laparoscopic radical hysterectomy (LRH). The mean duration of the postoperative catheterization, a questionnaire and an urodynamic examination were used to assess the bladder functions. : The mean duration of the postoperative catheterization in the LNSRH group was shorter than that in the LRH group (13 days versus 18 days,  < 0.01). The incidences of tension urinary incontinence, postoperative voiding time and dysuria symptoms in the LNSRH group, but not in the LRH group, had recovered to preoperative levels in the following 6 months. The frequency of nocturnal urination had recovered to preoperative level at 12 months post-operation in the LNSRH group. The maximum flow rate (MFR), average flow rate (AFR), first voiding sense (FVS), maximum voiding sense (MVS) and maximum detrusor pressure (MDP) in the LNSRH group were better than those in the LRH group ( < 0.05), and patients in the LRH group suffered much more frequently from tension urinary incontinence, prolonged urination time, dysuria and urinary endless compared with those in the LNSRH group ( < 0.05). : LNSRH can effectively retain the bladder function, but we should pay attention to the invasion of peripheral nerves.

摘要

根治性子宫切除术可能导致盆腔器官功能障碍和生活质量下降。本研究回顾性分析了298例行腹腔镜根治性子宫切除术的患者,其中216例行腹腔镜保留神经根治性子宫切除术(LNSRH),82例行经典腹腔镜根治性子宫切除术(LRH)。采用术后平均导尿时间、问卷调查和尿动力学检查来评估膀胱功能。LNSRH组术后平均导尿时间短于LRH组(13天对18天,<0.01)。LNSRH组压力性尿失禁、术后排尿时间和排尿困难症状的发生率在术后6个月恢复到术前水平,而LRH组未恢复。LNSRH组术后12个月夜尿频率恢复到术前水平。LNSRH组的最大尿流率(MFR)、平均尿流率(AFR)、首次排尿感觉(FVS)、最大排尿感觉(MVS)和最大逼尿肌压力(MDP)均优于LRH组(<0.05),且LRH组患者压力性尿失禁、排尿时间延长、排尿困难和尿不尽的发生率明显高于LNSRH组(<0.05)。LNSRH能有效保留膀胱功能,但应注意对周围神经的侵犯。

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