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目的:通过与传统全子宫切除术的比较,探讨保留神经的改良全子宫切除术对绝经前、后妇女排尿、排便功能的影响。方法:选择150例实施保留神经的改良手术的患者为研究对象,并以另150例实施传统全子宫切除术的患者为对照。于两组切除的子宫标本上分别取主韧带、骶韧带、膀胱宫颈韧带的切缘行S-100抗体的测定;根据患者是否绝经及绝经年限在两组内均分为绝经前期组、绝经早期组及绝经晚期组,分别比较术后1个月、1年的排尿及排便功能情况。结果:改良手术组的3组韧带切缘S-100阳性区域所占的面积比例均显著低于传统手术组;两组患者的手术时间、术中出血量及术后住院日比较无显著差异(P均>0.05);改良手术组患者术后1个月、1年的尿频、排尿等待、尿失禁以及便秘发生率均低于传统组;其中绝经前、绝经早期的两组患者比较,除绝经早期患者术后1个月尿频、排尿等待的发生率有统计学意义,其余均无统计学意义(P>0.05),而绝经晚期的患者改良手术组术后1个月、1年的尿频、排尿等待以及便秘发生率与传统手术组相比较均有显著差异。结论:改良子宫切除术较传统手术能减少支配膀胱直肠神经的损伤,降低患者术后尿频、排尿等待以及便秘的发生率,对绝经晚期的老年患者效果尤为显著。
OBJECTIVE: To investigate the effect of modified hysterectomy on the micturition and defecation in premenopausal and postmenopausal women by comparing with conventional hysterectomy. Methods: 150 patients who underwent modified surgery for nerve preservation were selected as the study subjects, and another 150 patients undergoing traditional hysterectomy were selected as controls. In the two groups of resected uterine specimens were taken from the main ligament, sacral ligament, the edge of the bladder cervical ligament line S-100 antibody determination; according to whether the patient is menopausal and menopausal years in both groups were divided into premenopausal group, early menopause Group and the menopausal group were compared postoperative 1 month, 1 year urination and defecation function. Results: The area proportion of S-100 positive area of the three groups in the modified operation group was significantly lower than that of the traditional operation group. There was no significant difference between the two groups in operation time, intraoperative blood loss and postoperative hospital stay P> 0.05). The frequency of urinary frequency, urinary incontinence, urinary incontinence and constipation of patients in the modified surgery group were significantly lower than those in the traditional group at 1 month and 1 year after operation. Among them, premenopausal and premenopausal women had no significant difference The frequency of urinary frequency and urination waiting time in one month after operation in the early patients was statistically significant (P> 0.05), while in the late menopausal patients, the urinary frequency, Urine waiting and the incidence of constipation compared with the traditional surgery group were significantly different. Conclusion: Compared with the traditional operation, the modified hysterectomy can reduce the damage to the bladder and rectum, and reduce the frequency of postoperative urinary frequency, urinary waiting and constipation, especially for elderly patients with late menopause.