| Objective:To observe the different changes of the vesical dysfunctions following radical hysterectomy(RH)with diverse acupuncture intervention occasions and acu-points selections.With the urination functions and the urodynamies of the RH patients following super-early intervention of body and scalp acupuncture synthetically analyzed,it provides an effective treatment method for the vesical dysfunctions following RH,which further ascertains the significant roles of the acupuncture for the rapid rehabilitation of surgeries.Methods:In total one hundred and fifty cases of cervical cancer which would receive total hysterectomy and lymphadenectomy,from the departments of gynecology and obstetrics,General Hospital of Guangzhou Military Command of PLA and 421 Hospital of PLA,from January 2013 to January 2016,were randomized into control group,treatment group 1,treatment group 2,treatment group 3 and treatment group 4,with 30 cases in each group.All the cases were routinely catheterized before the surgeries.On the 5th day following surgeries the catheters were clipped,and opened once every 2 to 3 hours.On the 7th day the catheters were firstly removed,and the patients were asked to drink more water.The residual urine volume(RUV)was measured with urethral catheterization.It was thought to successfully remove the catheter when the RUV was lower than 100 ml.While the RUV was higher than 100 ml,we would try to remove the catheter following the same schedules on the 10th day,the 14th day,the 21st day and the 25th day.In the control group,the routine diagnosis of western medicine without acupuncture was taken before and after the surgeries.In the treatment group 1,the scalp and body acupuncture was applied 2 days before the surgeries.In the treatment group two,the body acupuncture was used 2 days before the surgeries.In the treatment group 3,the scalp and body acupuncture was taken'2 days after the surgeries.And in the treatment group 4,the body acupuncture was applied 2 days after the surgeries,with 10 treatments in all the groups,and acupuncture was not applied on the day of surgeries.In the treatment group 1 and the treatment group 3,the scalp and body acu-points selected were as followed:scalp foot motor sensory area,Pangguanshu(BL 28),Ciliao(BL 32),Yinlingquan(SP 9)and Sanyinjiao(SP 6),and in the treatment group 2 and the treatment group 4,the body acu-points select.ed were as followed:Pangguanshu(BL 28),Ciliao(BL 32),Yinlingquan(SP 9)and Sanyinjiao(SP 6).Rational symptoms:The rational symptoms of the vesical dysfunctions in each group before surgeries,1 mouth,3 mouths and 6 mouths after surgeries were observed respectively,and the catheter retention time,catheter resetting following removal and the final residual urine volume while catheter removal were observed.The bladder function was assessed with the mesure du handicap urinaire(MHU)questionnaire.Objective indexes:Before the surgeries and 1 month,3 months and 6 months following the surgeries,according to the unified standards,the urodynanics of the patients were detected respectively by the designated doctors from the urodynamics room of urinary surgery department,General Hospital of Guangzhou Military Command of PL'A.The indexes included maximum flow rate(Qmax),bladder residual-urine volume(RV),catheter replacement rate,detrusor stability,first desire to void(FDV),maximum cystometric capacity(MCC)and detrusor pressure(Pdet)at Qmax.Results:There were in total 150 cases enrolled in the present study.Among them,4 cases in the control group,2 in the treatment group 1,3 in the treatment group 2,4 in the treatment group 3 and 2 in the treatment group 4 were dropped out due to the failure of urodynamics detection during the study.All the other 135 cases were successfully finished.Analyses of the baseline feature balance:There was no significant difference of the age structure,spontaneous labor numbers,pathological types,pathological stages,operation time and operative blood loss among the five groups(F=0.39,P=0.82>0.05;F=1.01,P=0.40>0.05;X2=5.52,P=0.70>0.05;X27.41,P=0.96>0.05;F=0.26,P=0.90>0.05;F=0.34,P=0.85>0.05),which consequently showed good baseline feature balance among the five groups with comparability.Subjective symptoms:1.Catheter retention time and final residual urine volumeThere was significant difference of the catheter retention time and final residual urine volume among the groups(F=43.47,P<0.05;F=15.16,P<0.05).The catheter retention time in the treatment groups 1 and 2 was obviously shorter than that in the control group and treatment group 3 and 4(all P=0.00<0.05).The final residual urine volume in the treatment group 1,2,3 and 4 was apparently lower than that in the control group(all P=0.00<0.05).2.The occurrence rate of subjective symptoms of the vesical dysfunction before and after surgeries among the five groups:Comparisons between before and after surgeries:In the control group,there was significant difference of the occurrence rate of the subjective symptoms of the vesical dysfunction before and after surgeries(X2=29.20,P=0.00<0.05).The occurrence rate of the subjective symptoms of the vesical dysfunction 1 month,3 months and 6 months after surgeries was obviously higher than that before surgeries(all P=0.00<0.05).In the treatment groups 1 and 2,there was no significant difference of the occurrence rate of the subjective symptoms of the vesical dysfunction before and after surgeries(X2=2.88,P=0.41>0.05;X2=1.45,P=0.69>0.05),and in the treatment groups 3 and 4,there was significant difference of the occurrence rate of the subjective symptoms of the vesical dysfunction before and after surgeries(X2=10.43,P=0.02<0.05;X2=20.18,P=0.00<0.05).Comparisons among the groups:Before the surgeries,there was no significant difference of the occurrence rate of the subjective symptoms of the vesical dysfunction among the five groups(X2=1.10,P=0.89>0.05).However,one month,3 months and 6 months following the surgeries,there was significant difference of the occurrence rate of the subjective symptoms of the vesical dysfunction among the 5 groups(X2=21.51,P=0.00<0.05;X2=20.49,P=0.00<0.05;X2=16.13,P=0.00<0.05).Among all the symptoms,dysuria after surgeries and abdominal micturition are the most commonly seen symptoms.In the control group,there was significant difference of the dysuria and abdominal micturition before and after surgeries(X215.93,P=0.00<0.05;X2=18.88,P=0.00<0.05).In the treatment group 1,there was no significant difference of the dysuria before and after surgeries(X2=3.97,P=0.27>0.05),but there was significant difference of the abdominal micturition before and after surgeries(X2=15.02,P=0.00<0.05).In the treatment group 2,there was significant difference of the dysuria and abdominal micturition before and after surgeries(X2=9.16,P=0.03<0.05;X2=10.71,P=0.01<0.05).In the treatment group 3,there was also significant difference of the dysuria and abdominal micturition before and after surgeries(X2=21.56,P=0.00<0.05;X2=15.70,P=0.00<0.05).In the treatment group 4,there was also significant difference of the dysuria and abdominal micturition before and after surgeries(X2=24.55,P=0.00<0.05;X2=16.51,P=0.00<0.05).Comparisons among the groups:Before the surgeries,there was no significant difference of the occurrence rate of dysuria and abdominal micturition among the five groups(X2=1.03,P=0.91>0.05;X2=8.11,P=0.09>0.05).One month after surgeries,there was significant difference of the occurrence rate of dysuria among the groups(X2=13.82,P=0.01<0.05),but no significant difference of the occurrence rate of abdominal micturition among the groups(X2=6.79,P=0.15>0.05).Three months after surgeries,there was significant difference of the occurrence rate of dysuria and abdominal micturition among the groups(X2=23.68,P=0.00<0.05;X2=19.66,P=0.00<0.05).Six months after surgeries,there was also significant difference of the occurrence rate of dysuria and abdominal micturition among the groups(X2=21.98,P=0.00<0.05;X2=18.47,P=0.00<0.05).3.MHU questionnaire scores before and after surgeries in the five groupsCompared before and after surgeries of the five groups,there was significant difference of MHU questionnaire scores before and after surgeries in the control group(F=165.07,P=0.00<0.05).In the treatment group 1,there was no significant difference of MHU questionnaire scores before and after surgeries(F=1.25,P=0.30>0.05).However,in the treatment group 2,3 and4,there was significant difference of MHU questionnaire scores before and after surgeries(F=151.22,P=0.00;F=195.43,P=0.00<0.05;F=171.72,P=0.00<0.05).Comparisons among the five groups:Before the surgeries,there was no significant difference of MHU questionnaire scores among the five groups(F=0.13,P=0.97>0.05).However,1 month,3 months and 6 months after the surgeries,there was significant difference of MHU questionnaire scores among the five groups(F=100.94,P=0.00<0.05;F=145.65,P=0.00<0.05;F=67.92,P=0.00<0.05).Objective indexes:Comparison before and after surgeries of the five groups:In the control group,there was significant difference of Qmax,RV,catheter replacement rate,detrusor stability,FDV,MCC and Pdet at Qmax before and after surgeries(F=20.61,P=0.00<0.05;F=79.00,P=0.00<0.05;X2=7.27,P=0.03<0.05;X2=11.98,P=0.01<0.05;F=37.42,P=0.00<0.05;F=16.64,P=.00<0.05;F=25.74,P=0.00<0.05).In the treatment group 1,there was no significant difference of Qmax,RV,catheter replacement rate,detrusor stability,FDV,MCC and Pdet at Qmax before and after surgeries(F=0.73,P=0.54>0.05;F=0.54,P=0.66>0.05;X2=2.03,P=0.57>0.05;X2=3.51,P=0.32>0.05;F=0.19,P=0.91>0.05;F=1.62,P=0.19>0.05;F=2.61,P=0.06>0.05).In the treatment group 2,there was significant difference of Qmax,RV,FDV and Pdet at Qmax before and after surgeries(F=12.35,P=0.00<0.05;F=102.86,P=0.00<0.05;F=30.78,P=0.00<0.05;F=25.56,P=0.00<0.05).However,there was no significant difference of catheter replacement rate,detrusor stability and MCC before and after surgeries(X2=3.03,P=0.39>0.05;X2=6.32,P=0.10>0.05;F=1.38,P=0.25>0.05).In the treatment group 3,there was significant difference of Qmax,RV,detrusor stability,FDV,MCC and Pdet at Qmax before and after surgeries(F=16.54,P=0.00<0.05;F=124.64,P=0.00<0.05;X2=15.74,P=0.00<0.05;F=31.30,P=0.00<0.05;F=20.7,P=0.00<0.05;F=25.44,P=0.00<0.05).However,there was no significant difference of catheter replacement rate before and after surgeries(X2=2.07,P=0.56>0.05).In the treatment group 4,there was significant difference of Qmax,RV,detrusor stability,FDV,MCC and Pdet at Qmax before and after surgeries(F=6.46,P=0.00<0.05;F=111.71,P=0.00<0.05;X2=14.42,P=0.00<0.05;F=32.30,P=0.00<0.05;F=14.93,P=0.00<0.05;X2=21.63,P=0.00<0.05).However,there was no significant difference of catheter replacement rate before and after surgeries(X2=3.76,P=0.29>0.05).Comparisons among the five groups:Before the surgeries,there was no significant difference of Qmax,RV,detrusor stability,FDV,MCC and Pdet at Qraax among the five groups(F=0.30,P=0.88>0.05;F=0.79,P=0.53>0.05;X2=5.44,P=0.24>0.05;F=0.34,P=0.85>0.05;X2=0.94,P=0.44>0.05;F=0.56,P0.69>0.05).One month after the surgeries,there was significant difference of Qmax,RV,Catheter replacement rate,FDV,MCC and Pdet at Qmax among the five groups(F=8.77,P=00<0.05;F=69.66,P=0.00<0.05;X2=17.04,P=0.00<0.05;F=22.43,P=0.00<0.05;X2=14.15,P=0.00<0.05;F=10.99,P=0.00<0.05).However,there was no significant difference of detrusor stability among the five groups(X2=5.39,P=0.25>0.05).Three months after the surgeries,there was significant difference of Qmax,RV,detrusor stability,FDV,MCC and Pdet at Qmax among the five groups(F=18.31,P=0.00<0.05;F=98.12,P=0.00<0.05;X2=18.49,P=0.00<0.05;F=22.07,P=0.00<0.05;X2=11.95,P=0.00<0.05;F=16.68,P=0.00<0.05).However,there was no significant difference of catheter replacement rate aMong the five groups(X2=6.21,P=0.18>0.05).Six months after the surgeries,there was significant difference of Qmax,RV,detrusor stability,FDV and MCC among the five groups(F=9.68,P=0.00<0.05;F=60.34,P=0.00<0.05;X2=24.56,P=0.00<0.05;F=0.18,P=0.95>0.05;X2=14.15,P=0.00<0.05).However,there was no significant difference of catheter replacement rate and Pdet at Qmax among the five groups(X2=8.11,P=0.09>0.05;F=1.96,P=0.10>0.05).Conclusions:1.The occurrence rate of vesical dysfunctions following RH for the cervical cancer patients was high,and the MHU scores obviously increased.The clinical symptoms were mainly manifested as abdominal micturition,dysuria and vesical tenesmus.In the control group,although the symptoms above 6 months after surgeries had the tendency of decreasing compared with those 1 month after surgeries,the symptoms were still obvious compared with those before the surgeries.2.After the RH surgeries for the cervical cancer patients,the Qmax was decreased,the occurrence rate of detrusor instability was increased,the FDV and MCC were increased,and the Pdet at Qmax was obviously decreased.3.The super-early intervention of body and scalp acupuncture to the cervical cancer patients following RH surgeries could obviously shorten the catheter retention time,decrease RV,decrease the occurrence rates of subjective symptoms of vesical dysfunctions,dysuria and abdominal micturition,lower the MHU scores,increase Qmax and Pdet at Qmax,decrease RV,FDV,MCC,the catheter replacement rate and the rate of detrusor instability while detecting the urodynamics,which is significant for the recovery of the bladder function and the improvement of the urodynamics indexes for the cervical cancer patients following the RH surgeries.4.The super-early intervention of body and scalp acupuncture had better therapeutic effects in the recovery of the bladder function and the improvement of the urodynamics indexes for the cervical cancer patients following the RH surgeries compared with that with simple acupuncture after the surgeries.The super-early intervention of body and scalp acupuncture had better therapeutic effects in the recovery of the bladder function and the improvement of the urodynamics indexes for the cervical cancer patients following the RH surgeries compared with that with simple body acupuncture.However,there was no significant difference of the recovery of the bladder function and the improvement of the urodynamics indexes for the cervical cancer patients following the RH surgeries with combined scalp and body acupuncture and simple body acupuncture after surgeries.For the period and acupuncture method selection to the cervical cancer patients following the RH surgeries,the super-early intervention may be of significance in the clinical practice. |
PDF Full Text Request