本文選題：廣泛子宮切除術(shù)　切入點(diǎn)：宮頸癌　出處：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：觀察因?qū)m頸癌與子宮內(nèi)膜癌行廣泛性子宮切除術(shù)(Radical Hysterectomy, RH),患者術(shù)后各隨訪時(shí)間點(diǎn)并發(fā)癥的表現(xiàn)與發(fā)生率。方法：前瞻性觀察在南方醫(yī)科大學(xué)南方醫(yī)院144例患者,因婦科惡性腫瘤行廣泛子宮切除術(shù)(Radical Hysterectomy, RH),記錄其圍手術(shù)期的損傷情況及術(shù)前、術(shù)后1月、3月、6月、1年、2年、3年、4年、5年的膀胱功能障礙、肛門直腸功能紊亂、性功能障礙等的主觀癥狀的發(fā)生率,以術(shù)后有無放療進(jìn)行分組,放療組57例,非放療組87例,評估放療對并發(fā)癥發(fā)生的影響。以Epidata3.1雙輸入建立數(shù)據(jù)文件庫,導(dǎo)出至SPSS13.0行統(tǒng)計(jì)分析。結(jié)果：144例患者,目前在訪109人,總計(jì)隨訪6163人月。其中在訪放療患者42人,無放療67人。(1)平均留置尿管時(shí)間(29.2±31.8)天,85例患者發(fā)生尿潴留(膀胱殘余尿量100m1),占59.0%。 (2)膀胱功能障礙表現(xiàn)排尿困難、尿不凈感、腹壓排尿等,在術(shù)后1月、3月、6月總發(fā)生率分別為81.9%、74.7%、59.2%,明顯高于術(shù)前；術(shù)后1年、2年發(fā)生率與術(shù)前無統(tǒng)計(jì)學(xué)差異；腹壓排尿持續(xù)存在至術(shù)后5年甚至更長。腹壓排尿術(shù)后1年放療組明顯高于無放療組,張力性尿失禁術(shù)后3月放療組明顯高于無放療組 (3)肛門直腸功能紊亂的發(fā)生率：肛門直腸功能紊亂以排便不凈感、排便習(xí)慣改變、便秘等表現(xiàn)為主；術(shù)后1月總發(fā)生率為55.4%,明顯高于術(shù)前；術(shù)后3月與術(shù)后1月相比亦有較高趨勢,但無明顯統(tǒng)計(jì)學(xué)差異,術(shù)后6月、1年、2年的肛門直腸功能紊亂總發(fā)生率與術(shù)前均無統(tǒng)計(jì)學(xué)差異。非炎性腹瀉或大便次數(shù)增多術(shù)后3月放療組明顯高于無放療組。 (4)性功能障礙：術(shù)后3月、6月恢復(fù)性生活的比率明顯低于術(shù)前,術(shù)后1年后逐漸至恢復(fù)術(shù)前水平；性功能障礙以副交感神經(jīng)損傷癥狀,以性喚起障礙、性交痛、陰道干燥、陰道彈性下降等為主；術(shù)后3、6月、1年、2年的總發(fā)生率分別為88.5%、82.4%、87.5%,明顯高于術(shù)前。性交痛、陰道干燥與陰道痙攣術(shù)后3、6月、1年放療組明顯高于無放療組 結(jié)論：廣泛子宮切除術(shù)(RH)的并發(fā)癥以盆腔自主神經(jīng)損傷為主要表現(xiàn),尤其是副交感神經(jīng)損傷的盆腔器官功能障礙為主。 1、膀胱功能障礙表現(xiàn)較為嚴(yán)重,發(fā)生率呈先升高后降低的趨勢,術(shù)后1年內(nèi)癥狀多樣,發(fā)生率明顯高于術(shù)前,1年后以腹壓排尿表現(xiàn)為主,且持續(xù)存在,其余癥狀在腹壓排尿的代償下消失。 2、肛門直腸功能紊亂主要表現(xiàn)為大便干結(jié),其發(fā)生率呈先上升后降低的趨勢,術(shù)后6月肛門直腸功能紊亂可逐漸恢復(fù)。 3、性功能障礙發(fā)生率高且持續(xù)存在。 4、放療對于RH術(shù)后并發(fā)癥的影響：放療對于性功能損傷較為明顯,但對膀胱功能、肛門直腸功能的影響不明顯。
[Abstract]:Objective: to observe the incidence and manifestation of postoperative complications after radical hysterectomy for cervical carcinoma and endometrial carcinoma.Methods: 144 patients with gynecological malignant tumors were studied prospectively. The perioperative injury and preoperative injury were recorded.The incidence of the subjective symptoms of bladder dysfunction, anorectal dysfunction, sexual dysfunction, and so on in patients with bladder dysfunction, anorectal dysfunction, and sexual dysfunction was divided into two groups: radiotherapy group (n = 57) and non-radiotherapy group (n = 87), according to whether there was radiotherapy or not, in the first month, 3 months, 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after operation.To evaluate the effect of radiotherapy on complications.The data file library is established by Epidata3.1 double input, and exported to SPSS13.0 row statistical analysis.Results of the 144 patients, 109 were currently interviewed, with a total follow-up of 6163 person-months.The average indwelling time of urethral catheter was 29.2 鹵31.8days in 42 patients with radiotherapy and 67 patients without radiotherapy. The retention of urine was observed in 85 patients (bladder residual urine volume was 100m1g, 59.0%).(2) the incidence of dysuria, dysuria, abdominal pressure and dysuria were 81.9%, 74.74.2% and 59.2% respectively in 1 month, 3 months and 6 months after operation, which were significantly higher than those before operation, but there was no significant difference in the incidence of 1 year and 2 years after operation.Abdominal pressure urination persisted until 5 years or more after operation.One year after abdominal pressure urination, radiotherapy group was significantly higher than that without radiotherapy group, and tension urinary incontinence group was significantly higher than no radiotherapy group in 3 months after operation.(3) the incidence of anorectal dysfunction: the main symptoms of anorectal dysfunction were defecation, defecation habits change, constipation, etc. The total incidence of anorectal dysfunction was 55.45.45%, which was significantly higher than that before operation.The total incidence of anorectal dysfunction in 6 months, 1 year and 2 years after operation was not significantly different from that before operation.The number of non-inflammatory diarrhea or stool increased significantly in radiotherapy group 3 months after operation than in non-radiotherapy group.(4) sexual dysfunction: the recovery rate of sexual life in 3 months and 6 months after operation was significantly lower than that before operation, and gradually recovered to the preoperative level 1 year after operation; sexual dysfunction was characterized by parasympathetic nerve injury, sexual arousal disorder, sexual intercourse pain, and vaginal dryness.The total incidence of vaginal elasticity was 82.4%, 87.5% and 87.5% respectively, which was significantly higher than that before operation, 3 months, 6 months, 1 year and 2 years after operation.Sexual intercourse pain, vaginal dryness and vagina spasm were significantly higher in radiotherapy group than in non-radiotherapy group 3, 6 months and 1 year after operation.Conclusion: the main complication of extensive hysterectomy is pelvic autonomic nerve injury, especially the pelvic organ dysfunction caused by parasympathetic nerve injury.1. The bladder dysfunction was more serious, the incidence rate increased first and then decreased. The symptoms were various in one year after operation, and the incidence rate was obviously higher than that before operation. After one year, abdominal pressure urination was the main manifestation, and it persisted.The rest of the symptoms disappeared under the compensatory effect of abdominal pressure on urination.2. The anorectal dysfunction was mainly characterized by stool dry knot, the incidence of which increased first and then decreased. The anorectal dysfunction could be gradually recovered 6 months after operation.3. The incidence of sexual dysfunction is high and persistent.4. The effect of radiotherapy on postoperative complications of RH: the effect of radiotherapy on sexual function injury was obvious, but not on bladder function and anorectal function.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R713.42

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