• 中国科技论文统计源期刊
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Volume 44 Issue 5
May  2019
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Effect of the radical hystcrectomy combined with vagina lengthening on sexual life in patients with cervical cancer

  • Corresponding author: ZHU Yan-ling, zhuyanling_1998@163.com
  • Received Date: 2016-09-20
    Accepted Date: 2018-11-21
  • ObjectiveTo analyze the effects of radical hystcrectomy combined with vagina lengthening on sexual life in patients with cervical cancer.MethodsEighty cervical cancer patients with type Ⅰb1 and type Ⅰb2~Ⅱa2 after neoadjuvant therapy were randomly divided into the control group and observation group(40 cases each group).The observation group was treated with radical hysterectomy combined with vaginal lengthening and retroperitoneal lymph node dissection, and the control group was treated with radical hysterectomy combined with retroperitoneal lymph node dissection.After 6 months of treatment, the vaginal change and sexual life in all patients were investigated using questionnaire, and the sexual function in two groups were evaluated using female sexual function measurement scale.ResultsThe differences of the number of cases and time of recovering regular sexual life between two groups were not statistically significant(P>0.05), the postoperative vaginal length in observation group was significantly better than that in control group(P < 0.01).The differences of the urination and defecation indicators between two groups were not statistically significant(P>0.05).The differences of the sexual arousal, orgasm, pain during intercourse, vaginal lubrication, sexual satisfaction, total score of female sexual function index and sexual desire between two groups were not statistically significant(P>0.05).ConclusionsThe radical hysterectomy combined with vagina lengthening in the treatment of cervical cancer can significantly prolong the vagina length, does not increase the risk of defecation and urination dysfunction, and significantly improves the quality of sexual life of patients.
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  • [1] 马佳佳, 陈必良.达芬奇机器人手术系统下保留盆腔自主神经宫颈癌广泛性子宫切除术肿瘤学安全性及临床疗效观察[J].实用医院临床杂志, 2015, 14(1):12. doi: 10.3969/j.issn.1672-6170.2015.01.005
    [2] 聂夏子, 刘钰, 曲波, 等.腹腔镜保留盆腔自主神经的广泛性子宫切除术治疗早期宫颈癌的研究进展[J].医学综述, 2015, 9(10):1786. doi: 10.3969/j.issn.1006-2084.2015.10.021
    [3] 韦奇秀, 龙海红, 吴瑞珍, 等.广泛性切除术联合阴道延长术对宫颈癌患者性生活状况的影响[J].广东医学, 2015, 25(12):1907.
    [4] 张楠.妊娠期宫颈癌的诊治进展[J].实用妇产科杂志, 2015, 31(2):101.
    [5] FAWCUS S, MOODLEY J.Postpartum haemorrhage associated with caesarean section and caesarean hysterectomy[J].Best Pract Res Clin Obstet Gynaecol, 2013, 27(2):233. doi: 10.1016/j.bpobgyn.2012.08.018
    [6] 朱彦玲, 章文华, 张红, 等.局部晚期宫颈癌术前新辅助治疗方案的比较[J].中华肿瘤杂志, 2013, 35(4):309. doi: 10.3760/cma.j.issn.0253-3766.2013.04.015
    [7] 毛小刚, 兰艳丽.早期宫颈癌采用保留盆腔植物神经的解剖性广泛性子宫切除术治疗的临床疗效[C].2015临床急重症经验交流高峰论坛论文集, 2015, 2(21): 87.
    [8] NOURI K, DEMMEL M, GREILBERGER U, et al.Prospective cohort study and meta-analysis of cyclic bleeding after laparoscopic supracervical hysterectomy[J].Int J Gynaecol Obstet, 2013, 122(2):124. doi: 10.1016/j.ijgo.2013.03.021
    [9] 靖丽华.宫颈癌广泛性子宫切除术中系统保留盆腔自主神经的临床效果分析[J].中国实用医药, 2015, 8(3):104.
    [10] SIESTO G, ORNAGHI S, IEDÀ N, et al.Robotic surgical staging for endometrial and cervical cancers in medically ill patients[J].Gynecol Oncol, 2013, 129(3):593. doi: 10.1016/j.ygyno.2013.02.030
    [11] 江玉娥, 丘媚妮, 陈海英, 等.腹腔镜在改良保留盆腔自主神经早期宫颈癌广泛性子宫切除术患者中的应用价值[J].中国药物经济学, 2015, 12(1):118.
    [12] VISSER L, DE GRAAF IM, MOL BW.Combination of foley bulb and vaginal misoprostol compared with vaginal misoprostol alone for cervical ripening and labor induction:a randomized controlled trial[J].Obstet Gynecol, 2013, 122(1):156. doi: 10.1097/AOG.0b013e318298df4a
    [13] 朱彦玲, 彭素蓉, 张红, 等.115例局部晚期宫颈癌术前腔内放疗与放化疗联合的近期疗效比较[J].江苏医药, 2013:39(10):60.
    [14] 李军, 游丹, 周炳秀, 等.保留盆腔自主神经的广泛性子宫切除术研究进展[J].江西中医药大学学报, 2015, 8(3):106.
    [15] 丁慧, 孔祥.腹腔镜下保留盆腔自主神经广泛性子宫切除术的应用进展[J].山东医药, 2015, 10(7):97. doi: 10.3969/j.issn.1002-266X.2015.07.038
    [16] WALLWIENER M, TARAN FA, ROTHMUND R, et al.Laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH):an implementation study in 1952 patients with an analysis of risk factors for conversion to laparotomy and complications, and of procedure-specific re-operations[J].Arch Gynecol Obstet, 2013, 288(6):1329. doi: 10.1007/s00404-013-2921-x
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Effect of the radical hystcrectomy combined with vagina lengthening on sexual life in patients with cervical cancer

    Corresponding author: ZHU Yan-ling, zhuyanling_1998@163.com
  • 1. Jiangsu Xuzhou Tumor Hospital Branch(Pipa Community Health Service Center of Gulou District of Xuzhou), Xuzhou Jiangsu 221000
  • 2. Department of Gynecology, Xuzhou Tumor Hospital, Xuzhou Jiangsu 221000, China

Abstract: ObjectiveTo analyze the effects of radical hystcrectomy combined with vagina lengthening on sexual life in patients with cervical cancer.MethodsEighty cervical cancer patients with type Ⅰb1 and type Ⅰb2~Ⅱa2 after neoadjuvant therapy were randomly divided into the control group and observation group(40 cases each group).The observation group was treated with radical hysterectomy combined with vaginal lengthening and retroperitoneal lymph node dissection, and the control group was treated with radical hysterectomy combined with retroperitoneal lymph node dissection.After 6 months of treatment, the vaginal change and sexual life in all patients were investigated using questionnaire, and the sexual function in two groups were evaluated using female sexual function measurement scale.ResultsThe differences of the number of cases and time of recovering regular sexual life between two groups were not statistically significant(P>0.05), the postoperative vaginal length in observation group was significantly better than that in control group(P < 0.01).The differences of the urination and defecation indicators between two groups were not statistically significant(P>0.05).The differences of the sexual arousal, orgasm, pain during intercourse, vaginal lubrication, sexual satisfaction, total score of female sexual function index and sexual desire between two groups were not statistically significant(P>0.05).ConclusionsThe radical hysterectomy combined with vagina lengthening in the treatment of cervical cancer can significantly prolong the vagina length, does not increase the risk of defecation and urination dysfunction, and significantly improves the quality of sexual life of patients.

  • 宫颈癌(cervical cancer,CC)发病年龄一般为40~50岁[1],为性生活活跃的人群[2]。近年宫颈癌的发病有逐渐低龄化趋势[3]。对于宫颈癌病人,治疗后的性功能状态对病人及其配偶来说都具有极其重要的意义。虽然根治性手术比根治性放疗更有利于病人性功能的保持,但由于手术范围广,术后阴道缩短、神经损伤等原因仍然制约着术后性功能的恢复。且术后常伴随着结直肠动力障碍、膀胱排空以及性功能障碍等严重的并发症,很大程度上影响了病人的性生活质量[4-5]。有文献[6]报道广泛性全子宫切除术联合阴道延长术可在一定程度上改善病人术后的性生活状态,但是对手术是否会加重病人并发症以及对性功能改善程度等方面的研究目前还较少。本研究对比宫颈癌根治术和根治术联合腹膜代阴道延长术病人的相关指标,探讨广泛性全子宫切除术联合腹膜代阴道延长术后病人的性生活情况及术后常见并发症等情况。现作报道。

1.   资料与方法
  • 选择2012年1月至2015年4月徐州市肿瘤医院收治的80例Ⅰb1期及新辅助治疗后的Ⅰb2~Ⅱa2期宫颈癌病人,均经病理确诊,其中鳞癌78例,腺癌2例。根据FIGO(2009)临床分期标准:Ⅰb1期6例,Ⅰb2期42例,Ⅱa2期32例。年龄29~50岁。将行广泛性全子宫切除术+腹膜后淋巴结清扫联合阴道延长术的病人纳入观察组,广泛性全子宫切除术+腹膜后淋巴结清扫术的病人纳入对照组,2组均为40例。入选标准:均有性伴侣;年龄≤50岁;宫颈癌治疗结束≥6个月;签订知情同意书。排除标准:合并其他部位肿瘤或肿瘤复发者;严重肝肾功能不全者;精神异常者。

  • Ⅰb1期病人直接手术,Ⅰb2~Ⅱa2期病人均行新辅助治疗并评价近期疗效后手术[7]。所有病人均经过2位或以上的副主任医师以上职称的妇瘤科医生进行妇科检查,并行盆腔磁共振检查,评估根治性手术的可行性。对照组病人仅行广泛性全子宫切除+腹膜后淋巴结清扫术,观察组病人在此基础上行腹膜代阴道延长术。手术操作由有丰富手术经验的医生进行。

  • 观察组病人在进行广泛性全子宫切除术以后再行阴道延长术。在阴道残端锁边缝合后对创面彻底止血。用可吸收线对已打开的膀胱后壁的腹膜返折和阴道前壁断端进行间断缝合,用于延长阴道前壁。然后将已打开的直肠前壁浆膜和阴道后壁断端间断缝合,延长阴道后壁。将直肠前壁浆膜和膀胱后壁腹膜在阴道断端的上方3~4 cm处进行缝合,封闭盆底腹膜,并一直延长到阴道的断端。

  • 术后病理检查若有腹膜后淋巴结转移、切缘肿瘤残存、宫旁受侵、宫颈深肌层浸润、脉管瘤栓或肿瘤低分化等危险因素者,术后辅助体外放疗加同步化疗。

  • 病人在手术后均进行定期的随访和问卷调查。术后6个月行第1次随访,术后7个月至1年每2个月随访1次。随访内容为排尿、排便情况、阴道变化、性生活相关情况。

  • 观察2组病人恢复正常规律生活所需的时间,恢复基本生活以后的情况以及其阴道长度;观察病人术后排便与排尿情况;使用女性性功能测量量表对病人的性功能进行估量:其中主要包括性唤起、性高潮、性交疼痛、阴道润滑、性满意度、女性性功能指数(FSFI)总分、性欲。均采用等级式对病人的性生活状态进行分级,有0~5级,得分越高表明性生活质量越好。

  • 采用t检验和χ2检验。

2.   结果
  • 2组病人术后恢复规律性生活的例数、恢复规律性生活所用时间比较差异均无统计学意义(P>0.05),观察组术后阴道长度明显优于对照组(P < 0.01)(见表 1)。

    分组 n 恢复规律性生活人数 恢复规律性生活所用时间/月 术后阴道长度/cm
    观察组 40 30 6.03±2.36 10.36±1.22
    对照组 40 28 5.89±2.06 6.33±1.01
    t 0.25* 0.28 16.09
    P >0.05 >0.05 < 0.01
    *示χ2
  • 2组病人在排尿和排便相关指标差异均无统计学意义(P>0.05)(见表 2)。

    分组 n 排尿相关症状 排便相关症状
    尿频 尿急 急迫性尿失禁 膀胱排空障碍 膀胱排空不全 尿痛 排便次数减少 排便困难 排便相关的疼痛 便失禁
    观察组 40 3 2 4 4 16 0 8 3 1 0
    对照组 40 4 3 5 7 14 1 9 4 1 1
    χ2 0.16 0.21 0.23 1.28 0.06 1.09 0.08 0.16 0.01 1.01
    P >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
  • 2组病人在性唤起、性高潮、性交疼痛、阴道润滑、性满意度、FSFI总分以及性欲等方面比较差异均无统计学意义(P>0.05)(见表 3)。

    分组 n 性高潮 性交疼痛 性欲 性唤起 阴道润滑 性满意度 FSFI总分
    对照组 40 1.90±0.88 2.15±0.50 2.02±0.85 2.26±1.08 2.11±0.50 2.08±0.36 12.46±1.22
    观察组 40 1.92±0.74 2.12±0.39 2.05±0.96 2.25±1.03 2.06±0.33 2.15±0.46 12.33±1.42
    t 0.11 0.30 0.15 0.04 0.45 0.64 0.37
    P >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
3.   讨论
  • 在我国妇科恶性肿瘤中宫颈癌居首位,不仅严重危害妇女的健康,而且对病人的生活质量和生命造成了很大的威胁[8-10]。近年来,其发病率逐年升高,并且逐渐年轻化。所以,目前威胁广大妇女生命安全以及健康的宫颈癌已逐渐成为社会广泛关注的一种疾病[11]。从20世纪开始,在宫颈癌中占有主导作用的治疗方式就是放疗和外科手术,对病人是进行单纯的子宫广泛性切除术还是结合化疗、放疗等方式都给病人提供了不同的治疗选择[12]。对局部晚期宫颈癌病人在新辅助治疗后行广泛性全子宫切除+腹膜外淋巴结清扫术也是保护病人性功能的一种方式[13]。但不论是单纯的手术还是联合放疗和化疗等,均会对病人造成一定的损害,导致不良反应的出现,例如结直肠动力障碍、膀胱排空障碍、性功能障碍以及不孕不育等[14]。由于宫颈癌年轻化的趋势,病人治疗后的生育功能和性功能等方面的问题也逐渐成为妇科肿瘤学界普遍关注的焦点。

    广泛性宫颈切除术为早期宫颈癌病人保留了子宫体及生育功能。但为保障疗效,阴道及宫旁的切除范围无法明显缩小,术后阴道长度至少会缩短3 cm或者以上,是影响术后病人性生活质量的重要因素之一。阴道的缩短导致性交出现困难,严重影响病人术后的性生活质量[15]。手术同时延长阴道是解决阴道缩短的有效方式,但未为临床广泛应用。本研究采用腹膜代阴道延长术,可达到延长阴道的目的。而且2组病人在恢复规律性生活的例数和恢复规律性生活所用时间的比较差异无统计学意义,2组病人在排尿、排便相关指标方面差异无统计学意义,提示虽然联合阴道延长术使手术操作难度增加、手术时间延长,但在膀胱、直肠等功能的恢复方面并不增加并发症的发生率。

    有报道[16]称通过延长阴道可以改善病人术后的性生活质量。但本研究结果显示2组病人在性唤起、性高潮、性交疼痛、阴道润滑、性满意度、FSFI总分以及性欲等方面评分的比较差异均无统计学意义。本研究中病人行联合阴道延长术后,阴道明显得到延长,但其性生活质量并没有见到明显提高,分析其可能的原因是病人在手术过程中阴道受到刺激导致感觉的异常,当然也不排除不同操作者手术技巧的问题。所以,宫颈癌病人术后性生活质量的研究还需要进一步探索。

    综上所述,宫颈癌病人行广泛性子宫切除联合腹膜代阴道延长术并不会增加其排便以及排尿方面的并发症,手术可以达到延长阴道解决性生活困难的问题,但对性生活质量没有明显改善,相关问题还有待进一步研究。

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