Ishibashi Masumi, Niikura Hitoshi, Ishida Motoko, Iwama Noriyuki, Metoki Hirohito, Shigeta Shogo, Nagai Tomoyuki, Tokunaga Hideki, Shimada Muneaki, Yaegashi Nobuo
Department of Obstetrics and Gynecology, Tohoku University School of Medicine.
Department of Obstetrics and Gynecology, National Hospital Organization Sendai Medical Center.
Tohoku J Exp Med. 2024 May 22;263(1):1-9. doi: 10.1620/tjem.2024.J014. Epub 2024 Feb 8.
The aim of this study was to determine the impact of nerve preservation confirmed by intraoperative electrical stimulation (IES) on subjective symptoms of urinary and sexual function in uterine cervical cancer patients who underwent radical hysterectomies. This study included 85 patients who underwent type C radical hysterectomy with IES. Pelvic splanchnic nerve preservation with IES after hysterectomy (nerve-stimulation positive group) was confirmed in 61 women and 24 women did not have nerve preservation (negative group). Urinary function was assessed with the Overactive Bladder Symptom Score (OABSS), International Prostate Symptom Score (IPSS), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaires. Sexual function was surveyed using the Female Sexual Function Index (FSFI). Longitudinal changes in those scores according to response to nerve-stimulation were evaluated using a generalized estimating equation. IPSS quality of life (QOL) scores were significantly better in the nerve-stimulation positive group compared with the scores in the negative group until 12 months after surgery, whereas OABSS, IPSS total, IPSS voiding, and ICIQ-SF scores evaluating urinary symptoms were not significantly different between the two groups. FSFI scores were better in the nerve-stimulation positive group 36 months after surgery compared with the scores in the negative group. In this study, we assessed self-reported urinary and sexual symptoms after nerve-sparing radical hysterectomy (NSRH) with IES in the long term. We demonstrated that nerve-sparing significantly reduced distress associated with QOL until 1 year, improved urinary storage symptoms at 2 years, and sexual symptoms 3 years after surgery.
本研究的目的是确定术中电刺激（IES）证实的神经保留对接受根治性子宫切除术的子宫颈癌患者泌尿和性功能主观症状的影响。本研究纳入了85例行C型根治性子宫切除术并接受IES的患者。61名女性在子宫切除术后通过IES证实保留了盆内脏神经（神经刺激阳性组），24名女性未保留神经（阴性组）。使用膀胱过度活动症症状评分（OABSS）、国际前列腺症状评分（IPSS）和国际尿失禁咨询问卷简表（ICIQ-SF）对泌尿功能进行评估。使用女性性功能指数（FSFI）对性功能进行调查。使用广义估计方程评估这些评分根据神经刺激反应的纵向变化。直到术后12个月，神经刺激阳性组的IPSS生活质量（QOL）评分显著优于阴性组，而评估泌尿症状的OABSS、IPSS总分、IPSS排尿评分和ICIQ-SF评分在两组之间无显著差异。术后36个月，神经刺激阳性组的FSFI评分优于阴性组。在本研究中，我们长期评估了接受保留神经根治性子宫切除术（NSRH）并接受IES的患者自我报告的泌尿和性症状。我们证明，保留神经在术后1年内显著减轻了与生活质量相关的痛苦，在术后2年改善了储尿症状，在术后3年改善了性症状。
