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·腹部疾病·

全子宫切除术后性功能障碍的检测及治疗效果研究*

作者:王 康1 李 环1,2 胡 艳2 杜 辉2 张巍颍2 王苏梅2 史军彩2 吴瑞芳2

所属单位:1.安徽医科大学北京大学深圳医院临床学院 (广东 深圳 518036)2.北京大学深圳医院妇产科、深圳市女性重大疾病早期诊断技术重点实验室 (广东 深圳 518036)

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摘要

目的 通过多种不同的方法对全子宫切除术后性功能状态进行检测,并通过电刺激治疗后再次检测,评估电刺激治 疗对性功能障碍的疗效。方法 选取2016年2月至2017年2月在北京大学深圳医院妇科行阴式全子宫切除的患者61 例,将其随机分为干预组(31例)、对照组(30例)。术后三月均行性功能检测。干预组在术后三月给予电刺激联合 生物反馈治疗,对照组常规护理,治疗一个疗程后对两组病人再次进行以上检测。比较两组患者的检测结果。结 果 ①干预组患者治疗前阴蒂棉签试验阳性13例(41.9%),对照组阳性16例(53.3%),两组之间差异无统计学意义(P >0.05)。②干预组患者治疗前性功能检测中,平均初始肌电位为(7.68±4.28)uV,对照组为(7.77±3.14)uV。两 组之间的差异无统计学意义(P>0.05)。③干预组患者治疗前性反应图形建立试验中平均峰高为(74.03±14.37)。 对照组患者为(73.60±9.19)。两组之间的差异无统计学意义(P>0.05)。④干预组患者电刺激治疗后阴蒂棉签 试验阳性27例(87.1%),对照组阳性为19例(63.3%),两组之间差异具有统计学意义(P<0.05)。⑤干预组患者治 疗后性功能检测中初始肌电位平均值为(11.97±6.71)uV。对照组患者为(7.90±3.74)uV。两组之间差异具有 统计学意义(P<0.05)。⑥干预组患者治疗后性反应图形建立试验中峰高平均值为(83.65±5.65)。对照组患者为 (71.23±8.21)。两组之间差异具有统计学意义(P<0.05)。结论 电刺激联合生物反馈治疗可显著改善全子宫切除术 后患者的盆底肌力,减少性功能障碍的发生。

Objective The sexual function status of the patients after total hysterectomy was examined by a variety of different methods, examined again after electrical stimulation treatment ,to evaluate the efficacy of electrical stimulation therapy for sexual dysfunction. Methods A total of 61 women after hysterectomy admitted to gynecology of Peking University Shenzhen Hospital from February 2016 to February 2017 were selected, and randomly divided into two groups. All patients were tested at three months postoperatively. Three months after surgery, 31 patients in intervention group accepted electrical stimulation combined with biofeedback therapy and 30 patients in control group accepted routine care. After the therapy, tested all patients. The results of two groups of patients were compared. Results ①In the intervention group, 13 cases (41.9%) were positive for the test of the cotton swab test before treatment, 16 cases (53.3%) were positive in the control group. There was no significant difference between the two groups(P>0.05).②Before treatment, the averageInitial electromyography in intervention group were (7.68±4.28)uV and in control group were (7.77±3.14)uV. There was no significant difference between the two groups(P>0.05).③Before treatment,the averagescore of Sexual response pattern establishment test in intervention group were 74.03±14.37 and in control group were (73.60±9.19). There was no significant difference between the two groups(P>0.05).④After treatment,27 cases (87.1%) were positive for the test of the cotton swab test in the intervention group, 19 cases (63.3%) were positive in the control group. There was significant difference between the two groups(P<0.05).⑤After treatment, the averageInitial electromyography in intervention group were (11.97±6.71) uV and in control group were (7.90±3.74)uV. There was significant difference between the two groups(P<0.05).⑥After treatment,the averagescore of Sexual response pattern establishment test in intervention group were (83.65±5.65) and in control group were (71.23±8.21). There was significant difference between the two groups(P<0.05). Conclusion Electrical stimulation combined with biofeedback therapy can significantly improve the pelvic floor muscle strength of patients after total hysterectomy, reducing the occurrence of sexual dysfunction.

【关键词】性功能障碍;性功能检测;电刺激;全子宫切除

【中图分类号】R713.4+2

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2017.02.018

前言

女性性功能障碍指女性个体不能参与她所期望的 性行为,其在性行为过程中不能得到或难于得到满 足,包括四种主要类型:性欲障碍、性唤起障碍、性 高潮障碍、疼痛性性障碍[1]。在临床工作中,我们发 现手术后组织结构的损伤导致的生理改变可能也是术 后性功能障碍的主要病因。并且一些新的研究已表 明,全子宫切除手术的确对女性生活质量及性功能有 不同程度影响,同时有一些其它的影响因素[2-3]。资 料表明电刺激联合生物反馈对治疗性功能障碍有相应 疗效[4],但对手术后尤其是全子宫切除后性功能障碍 的治疗资料尚少。我们希望通过电刺激联合生物反馈 干预治疗后疗效分析,为临床治疗性功能障碍提供新 的理论依据。