| Objective: To investigate the effects of different surgical approaches of total hysterectomy on the patient’s subjective level of pelvic floor function,analyze the impact of the surgical operation on pelvic floor function before and after total hysterectomy,as well as the incidence of major pelvic floor disorders after total hysterectomy,to provide relevant guidance and diagnosis and treatment basis for clinical work in the future.Methods: This study was a prospective cohort study,which included premenopausal women aged 40-55 years who received total hysterectomy for benign diseases such as myoma,adenomyomas,abnormal uterine bleeding and so on,and were treated in the Pelvic Floor Disease and Treatment Center,Shengjing Hospital of China Medical University from June 2019 to June 2020.Complete data of 105 patients were collected,including 49 patients in the laparoscopic hysterectomy group(TLH)and 56 patients in the abdominal hysterectomy group(TAH).Completed general demographic information were collected preoperative,Completed medical history collection,pelvic floor function impact questionnaire 7,pelvic floor dysfunction questionnaire 20,female sexual function index were collected preoperative,3 months after surgery,and 6 months after surgery respectively.And at the same time to investigate urinary system,digestive system related pelvic floor symptoms.,collected intraoperative blood loss,operative time,surgical outcome and preoperative and postoperative first laboratory review results(WBC,neutrophil count,neutrophil percentage,hemoglobin,red blood cell volume,hospitalization days),number of postoperative use of painkillers,length of stay in hospital,urethal catheter time,etc).Result:Comparison of the PFDI-20 of the two groups,In the POPDI-6 and CRADI-8column before operation、3 months after operation、6 months after operation and in the UDI-6 column before and 6 months after the operation P>0.05.In the UDI-6 column,there was a statistically significant difference in the scores of the two groups at 3 months after the operation.In the incidence of urinary system and digestive system symptoms between the two groups before and after operation P > 0.05.In both groups,the occurrence of subjective urinary system symptoms was most common in urinary incontinence,and stress urinary incontinence was dominant.The incidence of urinary incontinence was 27.61%(29/105),51.43%(54/105),52.38%(55/105)before,3 months after and 6 months after surgery,respectively.There were no significant differences in total FSFI score,six dimensions score and PFIQ-7 questionnaire score between TLH group and TAH group before and after hysterectomy(P>0.05).The scores of POPDI-6,CRADI-8 and UDI-6 before and after hysterectomy were further compared and analyzed.In the CRADI-8 and UDI-6 column,Comparison of 3 and6 months after operation with that before operation in columns CRDI-8 and UDI-6,comparison of 3 months after operation with that before operation in column POPODI-6,comparison of 6 months after operation with that before operation,and comparison of 6months postoperatively with that before opration showed statistical significance(P <0.05).There was no significant difference between 6 months after operation for CRDI-8and UDI-6 columns and 3 months after operation for POPDI-6 column(P > 0.05).The total score of FSFI and the scores of six dimensions of sexual function were lower than those before operation at 3 and 6 months after operation,and improved at 6 months after surgery compared with 3 months after surgery,but did not restore to the level before surgery.Paired comparison of each time node,there was a significant statistical difference compared with before surgery and 3 months after surgery,6 months after surgery compared with before surgery,6 months after surgery compared with 3 months after surgery(P<0.05).Conclusion: No matter what kind of total hysterectomy,both has adverse effects on patients’ short-term pelvic floor function,the incidence of postoperative urinary system symptoms,digestive system symptoms,sexual dysfunction and other pelvic floor dysfunction were significantly increased.There was no significant correlation between the occurrence of pelvic floor dysfunction and the surgical approach.The actual operation of total hysterectomy and its surgical treatment approaches damage to the long-term postoperative pelvic floor function and further follow-up observation and scientific research are still needed.How to further reduce the pelvic floor dysfunction after total hysterectomy during and after operation remains to be further studied. |
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