中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2014年
8期
609-615
,共7页
叶双%杨佳欣%曹冬焱%朱兰%郎景和%沈铿
葉雙%楊佳訢%曹鼕焱%硃蘭%郎景和%瀋鏗
협쌍%양가흔%조동염%주란%랑경화%침갱
宫颈肿瘤%子宫切除术%阴道%妇科外科手术%生活质量%性功能障碍,生理性%问卷调查
宮頸腫瘤%子宮切除術%陰道%婦科外科手術%生活質量%性功能障礙,生理性%問捲調查
궁경종류%자궁절제술%음도%부과외과수술%생활질량%성공능장애,생이성%문권조사
Uterine cervical neoplasms%Hysterectomy%Vagina%Gynecologic surgical procedures%Quality of life%Sexual dysfunction,physiological%Questionnaires
目的 评估早期(Ⅰb1～Ⅰb2期)子宫颈癌患者行子宫广泛性切除联合阴道延长术后的生命质量和性生活状态.方法 采用病例对照的研究方法和问卷调查的方式,对2008年12月至2012年9月间中国医学科学院北京协和医院妇产科收治的31例早期子宫颈癌患者行子宫广泛性切除联合阴道延长术(研究组),选择同期仅行子宫广泛性切除术的28例早期子宫颈癌患者作为对照组.在治疗结束至少6个月后,用已经被验证的欧洲癌症研究中心生命质量子宫颈癌(EORTC QLQ-CX24)问卷(主要研究子宫颈癌患者治疗后生命质量和性生活质量)及性生活和阴道变化(SVQ)问卷(进一步探讨妇科肿瘤患者术后性生活和阴道相关情况)评估其生命质量和性生活状态.结果 术后阴道长度研究组为(10.0±1.3) cm、对照组为(5.9±1.0)cm,两组比较,差异有统计学意义(P=0.000).随诊时已恢复规律性生活者研究组为68％(21/31)、对照组为64％(18/28),手术至恢复规律性生活的间隔时间(中位数)研究组为6个月(3～ 20个月)、对照组为5个月(1～12个月),两组分别比较,差异均无统计学意义(P＞0.05).所有患者术后常见的症状为膀胱排空障碍(17％,10/59)、膀胱排空不全(36％,21/59)和排便次数减少(25％,13/51)等排尿和排便的相关症状,但两组间比较,差异均无统计学意义(P＞0.05).所有患者术后多表现为性欲下降[88％(52/59)]、性高潮障碍[72％(28/39)]和性生活后放松感低[51％(20/39)],但两组间比较,差异均无统计学意义(P＞0.05).对照组与研究组[19％(4/21)]相比,对照组(12/18)患者自觉阴道长度缩短的表现更加明显(P＜0.05);但在阴道润滑度、性交痛等方面两组间无明显差异(P＞0.05).结论 早期子宫颈癌患者行子宫广泛性切除联合腹膜阴道延长术后阴道长度明显延长,患者自觉阴道缩短者明显减少,且并不增加术后排尿和排便相关症状的发生风险.所有患者术后均存在性功能障碍问题,应重视患者术后性功能的改善和恢复.
目的 評估早期(Ⅰb1～Ⅰb2期)子宮頸癌患者行子宮廣汎性切除聯閤陰道延長術後的生命質量和性生活狀態.方法 採用病例對照的研究方法和問捲調查的方式,對2008年12月至2012年9月間中國醫學科學院北京協和醫院婦產科收治的31例早期子宮頸癌患者行子宮廣汎性切除聯閤陰道延長術(研究組),選擇同期僅行子宮廣汎性切除術的28例早期子宮頸癌患者作為對照組.在治療結束至少6箇月後,用已經被驗證的歐洲癌癥研究中心生命質量子宮頸癌(EORTC QLQ-CX24)問捲(主要研究子宮頸癌患者治療後生命質量和性生活質量)及性生活和陰道變化(SVQ)問捲(進一步探討婦科腫瘤患者術後性生活和陰道相關情況)評估其生命質量和性生活狀態.結果 術後陰道長度研究組為(10.0±1.3) cm、對照組為(5.9±1.0)cm,兩組比較,差異有統計學意義(P=0.000).隨診時已恢複規律性生活者研究組為68％(21/31)、對照組為64％(18/28),手術至恢複規律性生活的間隔時間(中位數)研究組為6箇月(3～ 20箇月)、對照組為5箇月(1～12箇月),兩組分彆比較,差異均無統計學意義(P＞0.05).所有患者術後常見的癥狀為膀胱排空障礙(17％,10/59)、膀胱排空不全(36％,21/59)和排便次數減少(25％,13/51)等排尿和排便的相關癥狀,但兩組間比較,差異均無統計學意義(P＞0.05).所有患者術後多錶現為性欲下降[88％(52/59)]、性高潮障礙[72％(28/39)]和性生活後放鬆感低[51％(20/39)],但兩組間比較,差異均無統計學意義(P＞0.05).對照組與研究組[19％(4/21)]相比,對照組(12/18)患者自覺陰道長度縮短的錶現更加明顯(P＜0.05);但在陰道潤滑度、性交痛等方麵兩組間無明顯差異(P＞0.05).結論 早期子宮頸癌患者行子宮廣汎性切除聯閤腹膜陰道延長術後陰道長度明顯延長,患者自覺陰道縮短者明顯減少,且併不增加術後排尿和排便相關癥狀的髮生風險.所有患者術後均存在性功能障礙問題,應重視患者術後性功能的改善和恢複.
목적 평고조기(Ⅰb1～Ⅰb2기)자궁경암환자행자궁엄범성절제연합음도연장술후적생명질량화성생활상태.방법 채용병례대조적연구방법화문권조사적방식,대2008년12월지2012년9월간중국의학과학원북경협화의원부산과수치적31례조기자궁경암환자행자궁엄범성절제연합음도연장술(연구조),선택동기부행자궁엄범성절제술적28례조기자궁경암환자작위대조조.재치료결속지소6개월후,용이경피험증적구주암증연구중심생명질양자궁경암(EORTC QLQ-CX24)문권(주요연구자궁경암환자치료후생명질량화성생활질량)급성생활화음도변화(SVQ)문권(진일보탐토부과종류환자술후성생활화음도상관정황)평고기생명질량화성생활상태.결과 술후음도장도연구조위(10.0±1.3) cm、대조조위(5.9±1.0)cm,량조비교,차이유통계학의의(P=0.000).수진시이회복규률성생활자연구조위68％(21/31)、대조조위64％(18/28),수술지회복규률성생활적간격시간(중위수)연구조위6개월(3～ 20개월)、대조조위5개월(1～12개월),량조분별비교,차이균무통계학의의(P＞0.05).소유환자술후상견적증상위방광배공장애(17％,10/59)、방광배공불전(36％,21/59)화배편차수감소(25％,13/51)등배뇨화배편적상관증상,단량조간비교,차이균무통계학의의(P＞0.05).소유환자술후다표현위성욕하강[88％(52/59)]、성고조장애[72％(28/39)]화성생활후방송감저[51％(20/39)],단량조간비교,차이균무통계학의의(P＞0.05).대조조여연구조[19％(4/21)]상비,대조조(12/18)환자자각음도장도축단적표현경가명현(P＜0.05);단재음도윤활도、성교통등방면량조간무명현차이(P＞0.05).결론 조기자궁경암환자행자궁엄범성절제연합복막음도연장술후음도장도명현연장,환자자각음도축단자명현감소,차병불증가술후배뇨화배편상관증상적발생풍험.소유환자술후균존재성공능장애문제,응중시환자술후성공능적개선화회복.
Objective To investigate the quality of life and sexual function of cervical cancer patients following radical hysterectomy (RH) and vaginal extension.Methods Case-control and questionnaire-based method was employed in this study.Thirty-one patients of early-stage (Ⅰ b1-Ⅰ b2) cervical cancer who had undergone vaginal extension following classic RH in Peking Union Medical College Hospital from December 2008 to September 2012 were included in study group,while 28 patients with matching factors and RH only during the same period were allocated to control group.There was no significant difference between two groups in terms of clinical and demographic variables including age at diagnosis,tumor stage and follow-up time (P＞0.05).Patients were assessed retrospectively by validated selfreported questionnaires the European Organization for Research and Treatment of Cancer Cervix Cancer Module Questionnaire (EORTC QLQ-CX24) mainly for quality of life and sexual function for cervical cancer patients; the Sexual Function and Vaginal Changes Questionnaire (SVQ) further investigates sexual function and vaginal changes of patients with gynecologic malignancy at least 6 months after treatment.Results Vaginal length acquired by pelvic examination by gynecologic oncologists during follow-up visits was (10.0±1.3) cm and (5.9± 1.0) cm in study group and control group respectively (P=0.000).Sixty-eight percent (21/31) of cases in study group and 64％ (18/28) of cases in control group had resumed sexual activity at the time of interview,and the time interval between treatment and regular sexual activity was mean 6 months (range 3-20 months) and mean 5 months (range 1-12 months) in study and control group respectively,in which there was not statistical significance (P＞0.05).No difference was observed regarding pelvic floor symptoms (P＞0.05) while difficulty emptying bladder,incomplete emptying and constipation were most commonly reported.Both group presented with hypoactive sexual desire disorder [88％ (52/59)],orgasm dysfunction [72％(28/39)] and low enjoyment or relaxation after sex [51％(20/39)],which was not statistically significant (P＞0.05).Reduced vagina size and shorter vagina was more prominent in control group (12/18) than that in study group [19％ (4/21)] with statistical significance (P＜0.05),while no difference in sexual desire,vaginal lubrication,dyspareunia and sexual enjoyment (P＞0.05).Conclusions Patients with peritoneovaginoplasty following RH had much longer vagina and less self-perceived short vagina.Vaginal extension following RH does not worsen the pelvic floor symptoms.
