摘要
目的比较保留神经的广泛性子宫切除术(NSRH)与广泛性全子宫切除术(RH)对早期宫颈癌患者的膀胱功能影响,明确术后中医电针神经刺激疗法改善膀胱功能的有效性。方法前瞻性收集2019年1月—2020年12月在上海交通大学医学院附属仁济医院住院的早期宫颈癌患者97例,并随机分组:NSRH组32例,RH联合针灸[RH(A)]组32例,RH对照[RH(B)]组33例。其中,NSRH组和RH(B)组术后给予常规导尿管护理;RH(A)组在术后1周开始接受针灸治疗改善膀胱功能,治疗周期为12周。3组患者均在术前和术后13周进行尿动力学检查。结果NSRH组术后尿潴留的发生率(6.3%)显著低于RH(A)组(31.3%)和RH(B)组(36.4%,P值均<0.05)。术后13周尿动力学检查结果显示,RH(B)组的最大尿流率(MFR)、逼尿肌收缩正常和膀胱顺应性正常患者比例均显著低于NSRH组和RH(A)组,而初始尿意膀胱容量(FVS)和最大尿意膀胱容量(MVS)均显著大于NSRH组和RH(A)组(P值均<0.05),残余尿量(PVR)显著多于NSRH组和RH(A)组(P<0.05)。同组内比较发现,RH(B)组术后13周的MFR、逼尿肌收缩正常和膀胱顺应性正常患者比例均较术前显著降低,而FVS、MVS和PVR均较术前显著增大或增多(P值均<0.05)。结论采用RH联合中医电针神经刺激疗法治疗早期宫颈癌,可以在确保手术安全性、普及性的同时恢复患者的膀胱功能,提高其生活质量。
Objective To compare the effects of nerve-sparing radical hysterectomy(NSRH)and radical hysterectomy(RH)on the bladder function of patients with early cervical cancer,and to determine the effect of electroacupuncture nerve stimulation therapy on bladder function after surgery.Methods A total of 97 patients with early cervical cancer admitted to our hospital between January 2019 and December 2020 were prospectively collected and randomly divided into 3 groups:NSRH group(n=32),RH(A)group(n=32),and RH(B)group(n=33).NSRH group and RH(B)group received routine catheter care after surgery.RH(A)group began to receive acupuncture treatment to improve bladder function 1 week after the operation.The treatment period was 12 weeks.All the patients underwent urodynamic tests before surgery and 13 weeks after surgery.Results The incidence of postoperative urinary retention in the NSRH group(6.3%)was significantly lower than those in the RH(A)group(31.3%)and RH(B)group(36.4%,both P<0.05).Urodynamic results showed that the level of maximum flow rate(MFR)and proportions of patients with detrusor contraction and normal bladder compliance in RH(B)group were significantly lower than those in NSRH group and RH(A)group,while the levels of first voiding sense(FVS),maximum voiding sense(MVS)and postvoid residual(PVR)were significantly higher than those in NSRH group and RH(A)group at 13 weeks after operation(all P<0.05).In RH(B)group,the level of MFR and proportions of patients with detrusor contraction and normal bladder compliance at 13 weeks post operation were significantly lower than those before surgery,while FVS,MVS and PVR levels were significantly higher tham those before surgery.Conclusion Radical hysterectomy combined with electroacupuncture nerve stimulation therapy is safe and effective for early stage cervical cancer.It can restore patient’s bladder function as much as possible and improve their quality of life.
作者
叶太阳
李鹤
贡丽娅
孙思
祁宏
祝捷
YE Taiyang;LI He;GONG Liya;SUN Si;QI Hong;ZHU Jie(Department of Obstetrics and Gynecology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;不详)
出处
《上海医学》
CAS
2021年第7期521-524,共4页
Shanghai Medical Journal
基金
上海市综合医院中西医结合专项(ZHYY-ZXYJHZX-201904)。
关键词
宫颈癌
广泛性全子宫切除术
电针神经刺激疗法
针灸治疗
膀胱功能
Cervical cancer
Radical hysterectomy
Electroacupuncture nerve stimulation therapy
Acupuncture
Bladder function
