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目的 :探讨子宫切除术中宫颈去留的利弊 ,重新评价子宫次全切除术的应用价值。方法 :对 81例子宫次全切和 68例全切除两组病人术后性功能、膀胱功能、更年期症状、血脂及血液流变学情况进行对比 ,并观察残留宫颈情况。结果 :两组术后性功能、膀胱功能均下降 ,以全切组下降更为明显 (P <0 0 1或 0 0 5) ;两组甘油三脂 (TG)、胆固醇 (CHOL)、载脂蛋白B(APOB)、全血粘度及血浆粘度均高于正常对照组 ,载脂蛋白A(APOA)则均低于对照组 (P均 <0 0 1或 0 0 5)。上述各变化及更年期情况两组间相比差异无显著意义。残留宫颈均未发现 1例下垂、息肉或癌瘤 ,涂片均为巴氏Ⅰ或Ⅱ级。结论 :两种术式对卵巢功能早衰的影响是相同的 ,但对性生活与膀胱功能下降的影响全切组更为明显。提倡对每例患者都权衡宫颈去留之利弊 ,并与病人共同决定宫颈的去留 ,以提高手术满意度和术后生活质量。
Objective: To explore the advantages and disadvantages of cervical retention during hysterectomy and to evaluate the value of subtotal hysterectomy. Methods: The postoperative sexual function, bladder function, menopausal symptoms, blood lipid and hemorheology in 81 cases of subtotal hysterectomy and 68 cases of total resection were compared, and the residual cervical condition was observed. Results: The postoperative sexual function and bladder function of the two groups decreased, and the decrease was more obvious in the whole-cut group (P <0.01 or 0.55). The levels of TG, CHOL, The protein B (APOB), whole blood viscosity and plasma viscosity were higher than those in the normal control group, while the apolipoprotein A (APOA) was lower than that in the control group (P <0.01 or 0.05). The above changes and menopausal conditions between the two groups showed no significant difference. 1 case of residual cervical droop, polyps or cancer were not found, Pap smears were grade Ⅰ or Ⅱ. Conclusion: The two surgical procedures have the same effect on premature ovarian failure, but the effect on the decline of sexual life and bladder function is more obvious in the resection group. Advocated for each patient to weigh the pros and cons of cervical go to stay, and decide with the patient to go to stay in the cervix to improve surgical satisfaction and postoperative quality of life.