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目的对比分析不同程度保留盆腔自主神经(NSRH)的广泛子宫切除术和未保留盆腔自主神经患者术后对膀胱和直肠功能恢复的影响。方法选择2014-2016年在天津市宝坻区人民医院行腹腔镜广泛子宫切除术治疗的98例患者随机分为3组,在行腹腔镜广泛子宫切除术中未保留盆腔自主神经的患者32例为LRH组,术中保留一侧盆腔神经的患者33例为LUNSRH组,术中系统性保留盆腔自主神经的患者33例为LSNSRH组,比较3组患者手术指标、膀胱功能指标、直肠功能指标。结果3组患者术中出血量、术后住院时间、切除淋巴结个数、阴道切除长度、宫旁切除长度比较差异无统计学意义(P<0.05);LSNSRH组患者手术时间长于LUNSRH组患者,LUNSRH组患者长于LRH组患者,差异有统计学意义(P<0.05)。LSNSRH组患者术后尿管拔除时间、残余尿量、膀胱内压、膀胱功能并发症率较LUNSRH组患者下降,LUNSRH组患者较LRH组患者下降,差异有统计学意义(P<0.05)。LSNSRH组患者术后排气时间、直肠感觉阈值及直肠肛门抑制反射消失率、便秘发生率较LUNSRH组患者下降,LUNSRH组患者较LRH组患者下降,差异均有统计学意义(P<0.05)。结论腹腔镜广泛子宫切除术术中系统性保留盆腔自主神经虽然增加了手术难度和时间,但其可有效保护患者术后膀胱功能和直肠功能的恢复,患者术后康复获益明显优于未保留和保留一侧自主神经的患者。
Objective To compare and analyze the effects of extensive hysterectomy and pelvic autonomic nerve preserving pelvic autonomic nervous system (NSRH) on bladder and rectal functional recovery in different degrees. METHODS: A total of 98 patients undergoing laparoscopic radical hysterectomy from 2014 to 2016 in Baodi District People’s Hospital of Tianjin were randomly divided into three groups. Among the 32 patients who did not maintain pelvic autonomic nerve during laparoscopic radical hysterectomy, In the LRH group, 33 patients with intraoperative pelvic nerves retained the LUNSRH group, and 33 patients with systemic pelvic autonomic nerve preservation were LSNSRH group. Surgical indexes, bladder function indexes and rectal function indexes were compared between the three groups. Results There were no significant differences among the three groups in the amount of blood loss, postoperative hospital stay, number of resected lymph nodes, vaginal resection length and parauterum resection length (P <0.05). Patients in LSNSRH group had longer operation time than those in LUNSRH group, LUNSRH Patients in the group longer than LRH patients, the difference was statistically significant (P <0.05). The postoperative catheter extubation time, residual urine volume, intravesical pressure and bladder function complication rate in patients with LSNSRH were lower than those in patients with LUNSRH, and patients in LUNSRH group were significantly lower than those in patients with LRH (P <0.05). In LSNSRH group, the postoperative exhaust time, rectal sensation threshold and rectal anorectal reflex disappearance rate were significantly lower in patients with LUNSRH than in patients with LUNSRH (P <0.05). Conclusions Although laparoscopic radical hysterectomy, pelvic autonomic nerve preservation has increased the difficulty and time of operation, it can effectively protect patients from postoperative bladder function and rectal function recovery. The benefit of postoperative rehabilitation is better than that of unreserved And retain the side of the autonomic nerve patients.