| Cervical cancer ranks second in the world in female genital tract malignancies, the incidence rate increased significantly, and tend to be younger. At present, for younger patients with early cervical cancer, treatment principle is based on surgery, radiotherapy and chemotherapy, supplemented. Radical hysterectomy (RH)+pelvic lymph node dissection is proposed by Wertheim last century, became a classic surgical treatment of cervical cancer surgery, with experience, the effect of surgical treatment is getting better,5year survival rate has reached60-70%,5-year survival rate of early cases even up to880-97%. But RH surgery in obtaining significant effect also brings many complications following urethral/bladder dysfunction most serious postoperative morbidity at8%-80%, seriously affecting the quality of life of patients. A number of studies confirm that the above is mainly due to intraoperative complications of pelvic autonomic nerve (PAN) damage, so how to avoid and reduce damage PAN is the key to preventing complications.After many years of accumulation of clinical discovery, retention PAN program in two ways:First, reduce the extent of surgical resection, underwent modified radical hysterectomy (mRH), namely Piver type Ⅱ of surgery or QM Ⅱ type of surgery; Second-line reservations systematic nerve-sparing radical hysterectomy (SNSRH), RH surgery in the identification, retention PAN without cervical ligament resection narrow range, that QM C2type of surgery.Clinical studies carried out abroad on SNSRH Although many years, the effect is better, but less accumulated number of cases, no large sample of case reports. SNSRH surgery and achieved good effect, mainly for stays shorter catheter time, the incidence of bladder dysfunction decreased, only a few standard methods using urodynamic internationally recognized average bladder function to objectively assess SNSRH RH improve bladder function. On the other hand, SNSRH surgery there are still some bladder dysfunction, and postoperative follow-up RH widely varying duration cause bladder dysfunction reported incidence range, suggesting that with the extension of time after, the incidence of bladder dysfunction will change. Meanwhile, research on mRH bladder function improvement on RH less. So improve SNSRH/mRH postoperative bladder dysfunction to what extent? SNSRH/mRH RH after surgery for bladder dysfunction improvement is related to time? Require further study.This study was a prospective controlled study, from a subjective and objective aspects, including the use of indwelling catheter time, subjective symptom questionnaire method, a comprehensive assessment of bladder function urodynamic studies, the more time and dynamically compares RH/changes mRH/SNSRH bladder function, and to assess the degree of improvement programs in two nerve-sparing surgery for bladder dysfunction RH and improving time range, while the value of comparative clinical indicators of postoperative urodynamic evaluation of bladder function.Part One Dynamic Contrast study of subjective symptoms RH/mRH/SNSRH bladder dysfunction[Purpose]Application of dynamic assessment of subjective symptoms RH/mRH/SNSRH postoperative bladder dysfunction dynamic changes. [Method]Select90cases of cervical cancer and endometrial cancer patients met the inclusion criteria were randomly divided into three groups (RH group, mRH group, SNSRH group) conducted a prospective study, namely the implementation of RH surgery, mRH surgery, SNSRH surgery. Postoperative indwelling catheter time before recording, recording postoperative January, March, June, December subjective symptoms of bladder dysfunction, and with MHU Scale before surgery,1month,3months,6months and12months bladder function score.[Results]According to exclusion criteria, RH group included23cases, mRH group of29cases,20cases SNSRH groups studied. Three groups of age, diagnosis, histological type, tumor stage and grade, pelvic surgery, history of preoperative chemotherapy, postoperative radiotherapy and chemotherapy history, surgical approach was no significant difference (P>0.05). mRH operative time, blood loss were significantly less than the RH group and SNSRH group (F=6.998, P=0.002; F=5.683, P=0.020), while no significant difference between the RH group and SNSRH group.1. mRH group, SNSRH group of independent perioperative bladder voiding function recovery faster than the RH group. RH group, mRH group, indwelling catheter time between SNSRH groups were significantly different (F=11.933, P=0.001), mRH group, SNSRH group indwelling catheter time were significantly smaller than RH group (P=0.014; P=0.002), and among mRH group indwelling catheter group and SNSRH time no significant difference (P=0.328).2. mRH group, SNSRH significantly improve bladder dysfunction RH incidence of postoperative1year to improve significantly in the long-term bladder disorder. RH postoperative bladder dysfunction with dysuria, abdominal urination, urinary net performance-oriented sense, there are significant differences in the incidence (X2= 22.933, P=0.000) after surgery, in January, March, June before, in December were higher than surgery, and abdominal voiding performance persists. No incidence of bladder dysfunction after mRH operative significant difference (X2=5.966, P=0.202). SNSRH group exists before surgery the patient complained of symptoms of bladder dysfunction were significantly different (X2=15.700, P=0.003), the highest incidence of postoperative January, up65.0%, expressed as urinary frequency, urgency, dysuria, abdominal voiding pressure, but after June has been below50.0%after1year of incidence close to the preoperative level.3. mRH group, SNSRH group improved significantly serious postoperative bladder dysfunction RH1year degree. RH group MHU scores before and after surgery the presence of significant change (F=5.225, P=0.000), after1month,3months MHU scores were significantly higher than before surgery (P=0.005; P=0.048), and postoperative June, no significant difference (P=0.211, P=0.993) and preoperative scores before MHU December. mRH group, MHU scores before and after SNSRH group had no significant change surgery (F=1.122, P=0.345; F=1.868, P=0.188).[Conclusion]1. There is a serious RH postoperative bladder dysfunction, abdominal voiding a long time.2. Bladder dysfunction mRH not obvious.3. SNSRH presence of mild postoperative bladder disorder, but after a year returned to the preoperative level.4. mRH, SNSRH postoperative RH can significantly improve subjective symptoms of bladder dysfunction severity, while significantly improving the long-term incidence of abdominal pressure urination.Part Two RH/mRH/SNSRH bladder dysfunction objective dynamic comparative study[Purpose]From the perspective of objective criteria clearly RH/mRH/SNSRH bladder function after1year of dynamic change trend.[Method]The first part of the selected cases in the preoperative and postoperative March, June, December unified standard urodynamic studies, including uroflowmetry and filling bladder pressure measurement in two parts, including the maximum flow rate observed indicators, residual urine volume, voiding time, delay time urination, abdominal voiding detrusor stability, initial urine bladder capacity, maximum bladder capacity. RH group of23patients with a more complete urodynamic data, mRH group of29cases,20cases SNSRH groups.[Results]1. mRH group, SNSRH RH group can improve postoperative. Analysis before and after surgery to reduce the overall maximum flow rate Qmax obvious change (F=9.885, P=0.000), after3months,6months was significantly lower than before surgery (P=0.001; P=0.021), while after12months without significant difference (P=0.090) and preoperative. RH group before and after surgery where there is maximum flow rate change significantly (F=5.284, P=0.008), after3months,6months was significantly lower than before surgery (P=0.000; P=0.035), and postoperative December There was no significant difference (P=0.116) before surgery. mRH group after March maximum urinary flow rate was significantly lower than before surgery (P=0.008), after6months and12months was not statistically significant (P=0.123, P=0.827) compared with before surgery. Qmax was no significant change (F=3.081, P=0.061) after SNSRH operative.2. mRH group, SNSRH RH group can improve the potential risk of postoperative urinary retention occurred after1year. Although there is no residual urine volume significantly different among the three groups (F=0.569, P=0.243), and preoperative, after3months,6months, no significant difference (F between December3groups of bladder residual urine volume=41.570, P=0.119; F=0.135, P=0.874; F=0.064, P=0.938; F=0.752, P=0.475). But the incidence of urinary retention, RH significantly higher after December preoperative (X2=9.629, P=0.022), mRH group after3months,6months was significantly higher than the preoperative (X2=10.267, P=0.016), SNSRH group was significantly higher than the previous3months after surgery (X2=13.028, P=0.005).3. mRH group, SNSRH RH group can significantly improve the long-standing abdominal postoperative voiding. RH exist after abdominal surgery group significant difference in the incidence of urination (X2=10.147, P=0.017), after6months and12months abdominal urination significantly higher incidence of preoperative (P=0.002; P=0.007are<0.008). mRH after abdominal surgery group the incidence of voiding was no significant difference (X2=1.642, P=0.650). The incidence of abdominal urination after surgery group had SNSRH significant difference (X2=8.006, P=0.046), but after3months,6months and12months of abdominal voiding were not significantly higher incidence of preoperative (P=0.022; P=0.041; P=0.386, were>0.008).4. mRH group, SNSRH RH group can improve postoperative detrusor instability. RH group before and after surgery the incidence of detrusor instability significantly different (X2=9.222, P=0.026), postoperative detrusor instability significantly higher incidence of preoperative and biphasic changes after the first rise and fall of trend, after June the highest incidence of detrusor instability. No mRH group before and after surgery the incidence of detrusor instability (X2=3.000, P=0.072) were significantly different. SNSRH detrusor instability before and after surgery group were significantly different (X2=10.500, P=0.015),3months after the highest incidence of detrusor instability.5. mRH group3months after the initial impact on the bladder urine was significantly greater than the sense of RH group, SNSRH group, but the initial urine-based bladder capacity increases, less prone to bladder sensitive. RH group, the initial capacity of the bladder to urinate before and after SNSRH group did not significantly change surgery (F=1.690, P=0.178; F=2.732, P=0.083). mRH group after the initial surgery to urinate obvious change in bladder capacity (F=5.631, P=0.009),3months after the initial urine bladder capacity was significantly greater than the preoperative (P=0.008), while the former after6months and12months with surgery There was no statistically significant difference.6.RH group compared with postoperative maximum bladder capacity mRH group, SNSRH main effect was significantly increased Analysis RH group mean maximum bladder capacity was significantly greater than mRH group and SNSRH group (F=3.446, P=0.037), a separate analysis shows the effect after June when RH group maximum bladder capacity was significantly greater than mRH group, but no significant differences between SNSRH group (F=3.693, P=0.030), and preoperative and postoperative March, between December3groups maximum bladder capacity were not significantly difference (F=0.858, P=0.431; F=2.962, P=0.058; F=1.855, P=0.164).[Conclusion]1. There is a serious RH postoperative bladder dysfunction, the recent performance of the maximum flow rate is reduced, abdominal urination, urination prolonged detrusor instability, after1year mainly as abdominal voiding, and postoperative one year later there is the risk of urinary retention. RH after parasympathetic damage that persists long to urinate abdominal compensatory. 2. Bladder dysfunction mRH not obvious that mRH surgery showed no obvious pelvic autonomic nerve damage.3. SNSRH presence of mild postoperative bladder disorder, manifested as maximum flow rate is reduced, abdominal urination, urination prolonged detrusor instability, but after a year returned to the preoperative level. That SNSRH after a slight sympathetic, parasympathetic nerve damage, but return to normal after1year of basic autonomic function.4. mRH, SNSRH RH can significantly improve bladder dysfunction, taking into account the long-term effects on the pelvic abdominal voiding function is recommended in younger patients should be considered SNSRH treatment.Part Three Abdominal voiding study objective examination of compliance with subjective symptoms[Purpose]Explore the subjective symptoms of abdominal voiding questionnaire judgment and objective urodynamic abdominal voiding checks the consistency of the results.[Method]Select the first part, the second part of the enrolled patients before and after surgery in March, June, December subjective abdominal voiding symptom questionnaire data and abdominal voiding urodynamic data. A total of72patients, subjective symptoms questionnaire288passengers, urodynamic241passengers, select a complete survey data and subjective symptoms241passengers urodynamic data were analyzed.[Results]1, for all patients, subjective symptoms questionnaire for abdominal urination judgment and objective urodynamic findings are inconsistent (P=0.000).2, for patients without preoperative urodynamic abdominal urination, abdominal subjective symptoms questionnaire for urination judgment and objective urodynamic findings consistent (P=0.350).3, patients with preoperative urodynamic presence of abdominal urination, abdominal subjective symptoms questionnaire for urination judgment and objective urodynamic findings are inconsistent (P=0.000).[Conclusion]]Preoperative patients without abdominal urination, abdominal voiding their subjective symptoms consistent survey results and urodynamic findings. Urodynamic studies suggested poor compliance, preoperative patients without abdominal urination, abdominal available after voiding the existence of subjective symptoms of bladder function was speculated. |
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