针刺对360例子宫全切术后患者膀胱功能影响分析

ObjectiveTo analysis the clinical curative effect on bladder function recovery after radical hysterectomy with acupuncture and acu-physiotherapy.MethodsA total of 564 cervical cancer patients in the gynecology department who received radical hysterectomy from January 2011 to December 2017 in Qilu Hospital of Shandong University were collected. According to the inclusion and exclusion criteria, we studied 360 case records at last, with 120 cases respectively. Patients got treatment of acupuncture [acupuncture at Zhōngwǎn (中脘 CV12), Tiānshū (天枢 ST25), Shuǐdào (水道 ST28), Tàichōng (太冲 LI3), Sānyīnjiāo (三阴交 SP6), Zúsānlǐ (足三里 ST36) and Yīnlíngquán (阴陵泉 SP9)], or acu-physiotherapy with two large-size electrodes placed on the bladder area above the pubic symphysis besides acupuncture, from the 3rd day after operation once a day till the 14th day that removing the indwelling catheter. And the blank group got no other auxiliary treatment except scrubbed the meatus orifice with iodophor twice a day. We tested the residual urine volume 6 h later after removement of indwelling catheter. Residual urine volume more than 100 mL was defined as urinary retention, and the volume less than 50 mL was defined as adequate bladder emptying.ResultsWe analyzed patients’ age, the International Federation of Gynecology and Obstetrics (FIGO) stage, operation duration, amount of hemorrhage, depth of myometrium infiltration, cancer embolus, parametrium invasion, lymphatic metastasis, treating methods and residual urine volume recorded in case records, and there was no significant difference between every two groups (P >0.05). The incidences of urinary retention of the acupuncture group, the acu-physiotherapy group and the blank group were 24.17%, 21.67%, and 44.17%, indicating that both treating methods have significant effects (P <0.05), and acupuncture group was a little better than acu-physiotherapy group. The bladder function recovery rates of the 3 groups were 44.17%, 56.67%, and 40.83% correspondingly, which had significant difference between acu-physiotherapy group and blank group (P <0.05). Both acupuncture and acu-physiotherapy could reduce the incidence of urinary retention for the patients of Ib1 and IIa1 stages (P <0.01), whilst for patients of Ib2 and IIa2 stages, neither of the two methods was effective (P >0.05).ConclusionBoth acupuncture and acu-physiotherapy could prevent urinary retention after radical hysterectomy for local early cervical cancer (Ib1 and IIa1 stages) effectively, and acupuncture was a little more effective than acu-physiotherapy group. Acupuncture together with modulated medium frequency eletro-therapy could improve the cure rate of bladder function and minimize the residual urine volume.     

子宫内膜癌卵巢转移高危因素的Meta分析

目的:探讨子宫内膜癌发生卵巢转移的发病率并分析其危险因素,为年轻的子宫内膜癌患者是否保留卵巢提供一定的理论依据。方法:检索Pub Med、Embase、ISIweb of science、CNKI等数据库中发表的相关中文和英文文献,截至2016年9月。通过随机效应模型合并相对危险度RR(95%可信区间)进行分析,包括组织学分级、盆腔淋巴结转移、肌层浸润深度、宫颈浸润、子宫浆膜层浸润、腹水细胞学、淋巴脉管浸润、血清CA125水平和宫旁浸润等。结果:初检文献124篇,最终纳入8篇。Meta分析结果示,子宫内膜癌发生卵巢转移的高危因素有组织学分级(G3)(RR=2.09,95%CI为1.35~3.23)、盆腔淋巴结转移(RR=4.46,95%CI为3.09~6.45)、深肌层浸润(RR=3.02,95%CI为2.00~4.54)、宫颈浸润(RR=2.77,95%CI为1.83~4.20)、子宫浆膜层浸润(RR=16.93,95%CI为8.38~34.22)、腹水细胞学阳性(RR=4.16,95%CI为2.84~6.11)、脉管浸润(RR=2.03,95%CI为1.11~3.69)、血清CA12535U/ml(RR=3.27,95%CI为2.22~4.81)、宫旁浸润(RR=7.37,95%CI为3.89~13.97)。结论:约5%的子宫内膜癌患者发生卵巢转移。高组织学分级、盆腔淋巴结转移、深肌层浸润、宫颈浸润、子宫浆膜层浸润、腹水细胞学阳性、淋巴脉管浸润、血清CA125水平35U/ml和宫旁浸润是子宫内膜癌发生卵巢转移的高危因素。对于年轻的子宫内膜癌患者,是否选择保留卵巢应谨慎,应告知卵巢转移的潜在风险,充分做好术前及术中评估,如无高危因素,可考虑保留卵巢。