Objective: To compare the influence of postoperative pelvic floor function after different surgical procedures of hysterectomy. Methods: A total of 260 patients who underwent hysterectomy in Renmin hospital of Wuhan University from January 2012 to January 2014 were enrolled in the study, and divided into 5 groups by different surgical procedures, which were total abdominal hysterectomy (A-TH; 46 cases), total laparoscopic hysterectomy (L-TH; 59 cases), total vaginal hysterectomy (V-TH; 42 cases), abdominal intrafascial hysterectomy (A-CISH; 78 cases), laparoscopic intrafascial hysterectomy (L-CISH; 35 cases). Pelvic examination, pelvic organ prolapse quantitation (POP-Q), test of pelvic muscle strength, pelvic floor distress inventory-short form 20 (PFDI-20) and the female sexual function index (FSFI) questionnaire were measured after 6 months and 12 months. Results: The differences of pelvic organ prolapse incidence after 6 months, A-TH and A-CISH [7% (3/46) versus 3% (2/78)], A-TH and L-CISH [7% (3/46) versus 3% (1/35)] were statistically significance (all P<0.05).POP-Q grade after 6 months between A-TH and A-CISH was statistically different in degree (P<0.05). The differences of incidence of abnormal pelvic floor muscle fatigue after 6 months of A-TH and A-CISH [59% (27/46) versus 29% (23/78)], A-TH and L-CISH [59% (27/46) versus 26% (9/35)] were statistically significant (all P<0.05), after 12 months the difference of L-TH and A-CISH [61% (36/59) versus 29%(23/78)] was statistically different (P<0.05). The differences of incidence of abnormal pelvic floor muscle strength after 6 months of L-TH and A-CISH [53% (31/59) verus 24% (19/78)], V-TH and A-CISH [60% (25/42) verus 24% (19/78)], V-TH and L-CISH [60% (25/42) verus 23% (8/35)] were statistically significant (all P<0.05); after 12 months the difference of V-TH and A-CISH [57% (24/42) versus 26%(20/78)] was statistically significant (P<0.05). Stress urinary incontinence, abnormal bowel movements after 6 months and 12 months were no significant difference between groups (all P>0.05), PFDI-20 total score was not statistically significant (P>0.05). FSFI total score after 6 months and 12 months in A-TH and A-CISH, L-TH and A-CISH, A-CISH and L-CISH were statistically significant (all P<0.05). Conclusion: The influences of different surgical procedures to pelvic floor function are no statistical difference; as to the surgical resection of hysterectomy, intrafascia hysterectomy compared with extrafascia hysterectomy, the former is more helpful to the protection of the structure and function of the pelvic floor.
目的： 探讨不同方式的子宫切除术对患者术后盆底功能的影响。 方法： 选取2012年1月至2014年1月在武汉大学人民医院行子宫切除术的患者260例，按不同的手术方式分为：经腹筋膜外子宫切除术（A-TH；46例）、经腹腔镜筋膜外子宫切除术（L-TH；59例）、经阴道筋膜外子宫切除术（V-TH；42例）、经腹筋膜内子宫切除术（A-CISH；78例）、经腹腔镜筋膜内子宫切除术（L-CISH；35例），于术后6个月及12个月对患者进行病史采集、妇科检查、盆腔器官脱垂定量（POP-Q）分度、盆底肌力检查、评估盆底不适调查表简表（PFDI-20）、评估女性性功能指数问卷（FSFI）。 结果： 盆腔器官脱垂的发生率术后6个月A-TH与A-CISH[分别为7%（3/46）、3%（2/78）]、A-TH与L-CISH[为3%（1/35）]有差异（P<0.05）；POP-Q分度术后6个月A-TH与A-CISH在程度上有差异（P<0.05）。盆底肌疲劳度异常的比例术后6个月A-TH与A-CISH[分别为59%（27/46）、29%（23/78）]、A-TH与L-CISH[为26%（9/35）]有差异（P<0.05），术后12个月L-TH与A-CISH[分别为61%（36/59）、29%（23/78）]有差异（P<0.05）；盆底综合肌力异常的比例术后6个月L-TH与A-CISH[分别为53%（31/59）、24%（19/78）]、V-TH[为60%（25/42）]与A-CISH、V-TH与L-CISH[为23%（8/35）]有差异（P<0.05），术后12个月V-TH与A-CISH[分别为57%（24/42）、26%（20/78）]有差异（P<0.05）。压力性尿失禁、排便异常的发生率术后6个月、12个月各术式间均无差异（P>0.05），各术式间PFDI-20总分并无差异（P>0.05）。FSFI原始评分术后6个月及12个月在A-TH与A-CISH、L-TH与A-CISH、A-CISH与L-CISH间均有差异（P<0.05）。 结论： 不同的手术路径术后短期内对盆底功能的影响无统计学差异；不同的手术切除范围中，筋膜内子宫切除术与筋膜外子宫切除术比较，前者可能更有利于盆底结构和功能的保护。.
Zhonghua fu chan ke za zhi. 2017 May 25 [Epub]
A L Tan, L Hong, Y Z Zhao, L Jiang
Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, Chian.