腹腔镜下保留盆腔神经广泛子宫切除术对患者生活质量的影响

张亚男 卢秋阳 周宇 郭春霞

【摘要】目的：探讨腹腔镜下保留盆腔神经广泛子宫切除术（LNSRH）对患者膀胱、直肠肛门、性功能的影响。方法：以符合要求的60例子宫内膜癌患者作为研究对象，随机分组分为 LNSRH 组30例及腹腔镜下广泛子宫切除术（LRH）组30例，将患者术中术后情况及膀胱、直肠肛门功能、性功能恢复情况等各项指标进行对比。结果：两组患者均顺利完成腹腔镜下的手术操作，术中均无发生输尿管损伤、肠管损伤等严重并发症，对比 LRH 组， LNSRH 组手术时间长，出血量少，住院时间短，术后发生膀胱、直肠肛门、性功能异常发生率低（P <0.05）。结论： LNSRH 的广泛子宫切除术有助于减少术后后膀胱、直肠肛门、性功能障碍的发生率，可以提高患者术后生活质量。

【关键词】腹腔镜下;广泛性子宫切除术;盆腔自主神经;膀胱功能;直肠肛门功能

【中图分类号】R713.4【文献标识码】A 【文章编号】2096-5249（2021）22-0016-03

Influence of laparoscopic extensive hysterectomy with Pelvic nerve- preservation on the quality of life of Patients

Zhang Ya-nan， Lu Qiu-yang， Zhou Yu， Guo Chun-xia△

Department of Gynecology，Hongqi Hospital A?liated to Mudanjiang Medical College， Mudanjiang 157011， China

【Abstract】Objective：To investigate the e?ect of laparoscopic Pelvic nerve-preserving extensive hysterectomy（LNSRH） on the bladder，rectum and anus，and sexual function of Patients. Methods：Sixty patients with endometrial cancer who meet the requirements were selected as the research objects. They were randomly divided into laparoscopic extensive pelvic nerve-sparing hysterectomy（LNSRH）group 30 cases and laparoscopic extensive hysterectomy（LRH）group 30 cases，compare the patient's in- traoperative and postoperative conditions，bladder，rectal and anal function，and sexual function recovery. Results：The two groups of patients successfully completed the laparoscopic operation，and there were no serious complications such as ureteral injury and intestinal injury during the operation. Compared with the LRH group，the LNSRH group had a long operation time，less bleed- ing，and a short hospital stay. The incidence of abnormalities in bladder，rectum and anus，and sexual function was low（P<0.05）. Conclusion：Laparoscopic extensive hysterectomy with pelvic nerve preservation can help reduce the incidence of bladder，rectum and anus，and sexual dysfunction after surgery，and can improve the quality of life of patients after surgery.

【Key words】Laparoscopic;Extensive hysterectomy;Pelvic autonomic nerve;Bladder function;Rectum and anus function

子宫内膜癌作为女性生殖系统三大常见恶性肿瘤之一，随着经济发展及生活方式的变化，近年来发病率逐渐增加，在我国部分地区逐渐超过子宫颈癌达第一位[1]。早期子宫颈癌（ⅠA1-ⅡA2）和Ⅱ期子宫内膜癌治疗的常用术式是广泛子宫切除术（RH）和盆腔/腹主动脉旁淋巴结切除术[2]。这一术式经多项研究表明，不影响患者术后的复发率及生存率，有與传统RH相当的安全性和有效性，且有助于提高患者的生活质量[3]。但由于传统开腹手术下对神经辨认存在一定难度，随着腹腔镜技术的不断成熟，以腹腔镜为主的相关微创技术逐步用于恶性肿瘤的治疗，出现了腹腔镜下保留盆腔神经广泛子宫切除术（LNSRH），由于腹腔镜能将微观解剖图像放大5～10倍以上，有助于神经结构识别及分离、止血等精细操作，手术视野开阔，镜头方向和深度可调节，术野上比开腹手术暴露清晰，提高了手术可视化，精准解剖保留盆腔自主神经成为可能。……