Comparison in postoperative urination and defecation dysfunctions between laparoscopic and open radical hysterectomy
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摘要:目的 探讨腹腔镜根治性子宫切除术后排尿、排便功能障碍的发生情况。方法 将50例行根治性子宫切除术的宫颈癌患者根据手术方式分为腹腔镜组和开腹组，每组25例。比较2组患者术后排尿、排便功能恢复情况。结果 腹腔镜组术后住院时间、肛门排气时间、术中失血量均短于、低于开腹组，手术时间长于开腹组，差异有统计学意义(P < 0.05或P < 0.01)。开腹组发生尿失禁、急迫性尿失禁和膀胱敏感性上升的患者比率高于腹腔镜组，差异有统计学意义(P < 0.05或P < 0.01)。术后6个月时，腹腔镜组Wexner便秘评分系统(CSS)评分低于开腹组，差异有统计学意义(P < 0.05)。开腹组放化疗者术后6个月时CSS评分高于术前，腹腔镜组放化疗者术后6个月时佛罗里达克利夫兰诊所大便失禁评分(CCF-FIS)评分高于术前，差异均有统计学意义(P < 0.05)。结论 与开腹手术相比，腹腔镜根治性子宫切除术可以减少术后急迫性大小便失禁、膀胱感觉增强和便秘等远期并发症的发生。Abstract:Objective To explore the incidence of urination and defecation dysfunctions after laparoscopic radical hysterectomy.Methods Totally 50 cervical cancer patients with radical hysterectomy were divided into laparoscopy group and open surgery group according to the operation methods, with 25 cases in each group. The recovery conditions of postoperative urination and defecation functions were compared between the two groups.Results The postoperative hospital stay, anal exhaust time and intraoperative blood loss of the laparoscopic group were significantly lower or shorter than those of the open surgery group, while the operation time was significantly longer than the control group (P < 0.05 or P < 0.01). The ratios of patients with urinary incontinence, urgent urinary incontinence and increased bladder sensitivity in the open surgery group were significantly higher than that in the laparoscopy group (P < 0.05 or P < 0.01). At 6 months after operation, the score of Wexner Constipation Score System (CSS) in the laparoscopy group was significantly lower than that in the open surgery group (P < 0.05). The CSS score at 6 months after operation in the patients with chemoradiotherapy in the open surgery group was significantly higher than that before operation, and the score of the Fecal Incontinence Score of Cleveland Clinic in Florida (CCF-FIS) at 6 months after operation in the laparoscopy group was significantly higher than that before operation (P < 0.05).Conclusion Compared with open surgery, laparoscopic radical hysterectomy can reduce the incidence of long-term complications such as urgent urinary and fecal incontinence, bladder sensation enhancement and constipation.
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Keywords:
- cervical cancer /
- laparoscope /
- radical hysterectomy /
- dysfunction /
- constipation /
- urinary incontinence
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表 1 2组患者一般资料比较(x±s)[n(%)]
一般资料 腹腔镜组 开腹组 (n=25) (n=25) 年龄/岁 49.3±8.7 50.1±9.2 体质量指数/(kg/m2) 22.7(18.9~33.4) 22.4(17.6~34.1) 保留卵巢意愿 7(28.0) 5(20.0) FIGO临床分期 IA2 2(8.0) 1(4.0) IB1 15(60.0) 14(56.0) IB2 4(16.0) 6(24.0) IIA 4(16.0) 4(16.0) 组织学 鳞状 20(80.0) 22(88.0) 腺癌 4(16.0) 2(8.0) 腺鳞癌 1(4.0) 0 神经内分泌 0 1(4.0) 病理分级 G1 2(8.0) 4(16.0) G2 20(80.0) 20(80.0) G3 3(12.0) 1(4.0) 化疗 4(16.0) 6(24.0) 放疗 11(44.0) 11(44.0) FIGO: 国际妇产科联盟。 
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表 2 2组手术相关指标比较(x±s)[n(%)][M(IQR)]
指标 腹腔镜组(n=25) 开腹组(n=25) 留置导尿管时间/d 8.0(4.0~13.0) 7.0(5.0~13.0) 术后住院时间/d 10.7±4.4* 12.9±4.6 病理分级 G1 2(8.0) 发热 9(36.0) 10(40.0) 肛门排气时间/h 16.0±4.5** 36.4±9.5 手术时间/min 260.0(110.0~380.0)* 220.0(120.0~360.0) 术中失血量/mL 190.0(40.0~400.0)** 370.0(150.0~800.0) 清扫盆腹腔淋巴结数目/个 19.7±8.2 20.6±9.4 与开腹组比较, *P < 0.05, **P < 0.01。
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表 3 2组术后泌尿系症状比较[n(%)]
泌尿系症状 腹腔镜组 开腹组 (n=25) (n=25) 尿液存储症状 尿频 2(8.0) 1(4.0) 夜尿增多 6(24.0) 9(36.0) 尿急 2(8.0) 2(8.0) 尿失禁 10(40.0)** 18(72.0) 压力性 6(24.0) 8(32.0) 急迫性 4(16.0)* 10(40.0) 混合性 0 0 组织学 鳞状 20(80.0) 22(88.0) 完全性 0 0 膀胱敏感性上升 1(4.0) 0 神经内分泌 2(8.0)* 6(24.0) 膀胱敏感性下降 3(12.0) 1(4.0) 排尿症状 尿流中断 3(12.0) 2(8.0) 尿滴沥 1(4.0) 0 排尿踌躇 3(12.0) 3(12.0) 排尿后症状 排尿不尽感 2(8.0) 2(8.0) 生殖器和下尿路疼痛 膀胱疼痛 5(20.0) 3(12.0) 尿道疼痛 2(8.0) 1(4.0) 阴道疼痛 1(4.0) 1(4.0) 盆腔疼痛 2(8.0) 0 与开腹组比较, *P < 0.05, **P < 0.01。
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表 4 腹腔镜组放化疗者与无放化疗者术后6个月泌尿系症状比较[n(%)]
泌尿系症状 无放化疗者 放化疗者 (n=10) (n=15) 尿液存储症状 尿频 1(10.0) 1(6.7) 夜尿增多 2(20.0) 4(26.7) 尿急 1(10.0) 1(6.7) 尿失禁 40(40.0) 6(40.0) 膀胱敏感性上升 1(10.0) 1(6.7) 膀胱敏感性下降 1(10.0) 2(13.3) 排尿症状 尿流中断 1(10.0) 2(13.3) 尿滴沥 1(10.0) 0 排尿踌躇 2(20.0) 1(6.7) 排尿后症状 排尿不尽感 1(10.0) 1(6.7) 生殖器和下尿路疼痛 膀胱疼痛 2(20.0) 3(20.0) 尿道疼痛 1(10.0) 1(6.7) 阴道疼痛 0 1(6.7) 盆腔疼痛 1(10.0) 1(6.7)
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表 5 开腹组放化疗者与无放化疗者术后6个月泌尿系症状比较[n(%)]
泌尿系症状 无放化疗者 放化疗者 (n=8) (n=17) 尿液存储症状 尿频 1(12.5) 0 夜尿增多 3(37.5) 6(35.3) 尿急 1(12.5) 1(5.9) 尿失禁 6(75.0) 12(70.6) 膀胱敏感性上升 2(25.0) 4(23.5) 膀胱敏感性下降 0 1(5.9) 排尿症状 尿流中断 1(12.5) 1(5.9) 尿滴沥 0 0 排尿踌躇 1(12.5) 2(11.8) 排尿后症状 排尿不尽感 1(12.5) 1(5.9) 生殖器和下尿路疼痛 膀胱疼痛 1(5.9) 2(11.8) 尿道疼痛 1(12.5) 0 阴道疼痛 0 1(5.9) 盆腔疼痛 0 0
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表 6 2组术后6个月时便秘及排便控制评分比较[M(IQR)]
分 指标 腹腔镜组(n=25) 开腹组(n=25) CSS 0(0~11.0)* 2.0(0~16.0) CCF-FIS 1.0(0~8.0) 0.5(0~8.0) CSS: Wexner便秘评分系统;
CCF-FIS: 佛罗里达克利夫兰诊所大便失禁评分。
与开腹组比较, *P < 0.05。
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表 7 2组无放化疗者与放化疗者手术前后便秘及排便控制评分比较[M(IQR)]
分 指标 组别 术前 术后6个月 CSS 腹腔镜组(n=25) 无放化疗者(n=10) 0.5(0~12.0) 1.0(0~11.0) 放化疗者(n=15) 1.0(0~10.0) 1.0(0~11.0) 开腹组(n=25) 无放化疗者(n=8) 2.0(0~10.0) 1.0(0~12.0) 放化疗者(n=17) 1.0(0~11.0) 3.0(0~13.0)* CCF-FIS 腹腔镜组(n=25) 无放化疗者(n=10) 0(0~4.0) 0.5(0~5.0) 放化疗者(n=15) 0(0~6.0) 1.5(0~8.0)* 开腹组(n=25) 无放化疗者(n=8) 0(0~7.0) 0(0~6.0) 放化疗者(n=17) 0(0~6.0) 1.0(0~8.0) 与术前比较, *P < 0.05。
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