| Objective: Cervical cancer is a type of gynecological malignant tumors and its incidence rate increases over time in the recent years. Cervical cancer now becomes the second most common cancer in women living in less developed regions(second to breast cancer). Currently, the most effective treatment for stage I and II is radical hysterectomy combined with extraperitoneal pelvic lymphadenectomy. Due to the radicality of the operations and surgical trauma, different degrees of inevitable damages have been caused to the nerves, muscles, and blood vessels that are involved in the control of the bladder, weakening the bladder detrusor contractions and affecting the functions of the urinary system. It is reported that the incidence rate of post-operative complications of urinary retention is between 7.5%-44.9%. Currently, urine dynamics test has been used internationally for measuring and studying post-operative bladder dysfunction mechanisms and outcomes of treatments. The urine dynamics test provides direct and quantitative measurements for evaluation of the function and efficiency of the bladder and lower urinary tract, so as to provide objective evidence for clinical studies and evaluations. Therefore, the urine dynamics test is used in this study to evaluate the bladder function in patients who experience post-operative complications of urinary retention, with further discussions on the mechanism.Currently, there is no drug treatment in western medicine that has been reported to have therapeutic effect. The bladder washout technique is mainly used in the patients who have indwelling urinary catheter to prevent infection in the bladder, during the period of self-healing and recovery of the bladder function. However, bladder washout does not have an ideal clinical effect in patients with permanent damage to the bladder or permanent voidingdysfunction, and these patients would have to wear the indwelling urinary catheter for a long time that profoundly affects their quality of life. Patients who experience post-operative urinary retention may need long-term use of indwelling urinary catheter that is left in the bladder. Repetitive insertions of the urinary catheter may induce infections in the urinary system, increasing patient’s psychological stress and affecting subsequent treatment and recovery.One the other hand, Chinese traditional medicine has prominent advantages in this aspect, and acupuncture treatment has been reported in literature to have therapeutic effects. Acupuncture has been reported to have clinical effects in the treatments of injuries in peripheral nerves, and multiple selections of acupuncture points could be provided. This study uses acupuncture to treat post-operative urinary retention in patients with cervical cancer, and has observed significant clinical outcome in many years of clinical experience.The acupuncture treatment helps the patients with early removal of urethral catheters and pain relief, so as to prepare the patients for subsequent treatment.The object of this research is to observe the clinical therapeutic effect of acupuncture treatment for cervical cancer post-operative urinary retention, to provide clinical evidence for developing safe and reliable operations that are well regulated and have significant clinical effects.Methods: 90 cases of post-operative urinary retention in patients with cervical cancer were selected in this study. Prior to the study, all the patients underwent cervical biopsy and were diagnosed with cervical cancer, and have been treated with transabdominal radical hysterectomy. The urinary retention cases have been classified into three different levels(mild, moderate, and severe) based on the volume of residual urine level in the bladder that could be measured by ultrasound. Urinary retention with more than 300 ml residual urine is classified in severe level; with greater than or equal to 200 ml and less than 300 ml residual urine is in moderate level; with more than 100 ml and less than 200 ml is in mild level. The patients are randomly divided into the treatment group and two control groups(control group 1 and control group 2),with 30 cases in each group. There are no significant differences(P > 0.05)among the three groups regarding disease stages, ages, levels of urinary retention, urine dynamics test results, residual urine volumes, time periods of the use of urinary catheter, etc. In the control group 1, the patients wearing indwelling urinary catheters were treated once per day using bladder washout technique with 500 ml of 0.9% sodium chloride mixed with 160000 U gentamicin. In the control group 2, the patients were treated in the same way as in control group I, and additionally received three intramuscular injection at gluteal region with 0.5 mg neostigmine every other day once on day 2, total injection 6 times in the course. In the treatment group, the patients were treated in the same way as in control group I, and additionally receive acupuncture treatment. The main acupuncture points include baihui(DU20),guanyuan(RN4), zhongji(RN3), and taixi(KI3), while the reinforcing acupuncture points include qihai(RN6), lieque(LU7), shuidao(ST28),sanyinjiao(SP6), zusanli(ST36), yinlingquan(SP9), and taichong(LR3). The patients in the treatment group lay on their back, and were acupunctured in the baihui(DU20) point in the horizontal direction, in the lieque(LU7) point in a concentric tilted direction, and in other points in directions that are perpendicular to the skin. The reinforcing acupuncture points such as Baihui(DU20), Guanyuan(RN4), Taixi(KI3), and Zusanli(ST36) were acupunctured in a reinforcement way, while the points such as lieque(LU7),zhongji(RN3), shuidao(ST28), taichong(LR3), sanyinjiao(SP6), and yinlingquan(SP9) were acupunctured in an even reinforcing and reducing movement. The treatment courses for the treatment ground and two control groups lasted twelve days, and on the thirteen day examinations are carried out,including urine dynamic tests and measurements of residual urine volumes by ultrasound. If the residual urine volume in the patient’s bladder is less than100 ml, there is no need to insert urinary catheter in the patient and the treatment is effective. If the residual urine volume in the patient’s bladder is equal to or more than 100 ml, so the treatment is invalid and the patients need to reset the catheter. The patients in the treatment group and two control groups went through one treatment course, and results of the urine dynamictests and measurements of residual urine volumes were compared and analyzed according to evaluation standards of clinical effects in Western medicine and Chinese medicine.Results:Prior to the treatment, there are no significant differences(P >0.05) among the three groups regarding disease stages, ages, levels of urinary retention, urine dynamics test results, residual urine volumes, time periods of the use of urinary catheter, etc.1 After the one course of treatment, the urine dynamics test results of the three groups are compared and analyzed. The maximum urinary flow in the treatment group was 21.14±4.83 ml; in control group 1 was 14.65±5.12 ml; in control group 2 was 17.32±4.21 ml. The difference between the treatment group and the control groups was statistical significant(P < 0.01). The average urinary flow rate in the treatment group was 12.05±5.56 ml; in control group 1 was 7.95±4.31 ml; in control group 2 was 9.37±4.88 ml. The difference between the treatment group and the control groups was statistical significant(P < 0.05). The voided volume in the treatment group was339.58±147.26 ml; in control group 1 was 197.20±139.54 ml; in control group2 was 259.13±126.74 ml. The difference between the treatment group and the control groups was statistical significant(P < 0.01). The flow time in the treatment group was 28±13 s; in control group 1 was 36±15 s; in control group2 was 32±12 s. The difference between the treatment group and the control groups was statistical significant(P < 0.05).2 After the one treatment course, the volumes of the residual urine in the patients of the treatment ground and two control groups are compared. The residual urine volume in the treatment group is 54.46±70.52ml;in the control group 1 is 199.87±139.29ml;in the control group2 is 151.52±136.09 ml. The difference between the treatment group and the control groups was statistical significant(P < 0.05).3 After the one treatment course, patients are evaluated according to the evaluation standard in Western medicine. In the treatment group, patients in16 cases were recovered(53.3%), in 13 cases were improved(43.3%), and in1 cases no effect were observed(3.3%). In the control group 1, patients in 3cases were recovered(10.0%), in 7 cases were improved(23.3%), and in 20 cases no effect were observed(66.7%). In the control group 2, patients in 6cases were recovered(20.0%), in 10 cases were improved(33.3%), and in 14 cases no effect were observed(46.7%). The rate of effective treatment in the treatment group is 96.7%, in the control group 1 is 33.3%, in the control group2 is 53.3%。According to the Chi-square test, the difference was statistical significant(P < 0.05).4 After the one treatment course, patients are evaluated according to the evaluation standard in Chinese medicine. In the treatment group, patients in 26 cases were recovered(86.7%), in 3 cases were improved(10.0%), and in 1case no effect was observed(3.3%). In the control group 1, patients in 10 cases were recovered(33.3%), in 2 cases were improved(6.7%), and in 18 cases no effect was observed(60.0%). In the control group 2, patients in 16 cases were recovered(53.3%), in 2 cases were improved(6.7%), and in 12 cases no effect were observed(40.0%). The rate of effective treatment in the treatment group is 96.7%, in the control group 1 is 40.0%, in the control group2 is 60.0%。According to the Chi-square test, the difference was statistical significant(P < 0.05).No adverse affects and reactions were observed in this study. The treatment is safe to the patients.Conclusions:1 According to the urinary dynamics evaluations of the three groups, the treatment group showed remarkable improvement in the patient’s maximum urinary flow rate and average urinary flow rate, significantly better than two control groups.2 According to comparison of residual urine volume of the three groups,the treatment group showed remarkable reducement in the patient’s residual urine volume, significantly better than two control groups.3 According to the evaluation standard in western medicine, the efficiency of treatment group was significantly better than two control groups.4 According to evaluation standard in Chinese medicine, the efficiency of treatment group was significantly better than two control groups.5 Acupuncture has proven effect in the treatment of post-operative urinary retention in patients with cervical cancer. |
PDF Full Text Request