不同子宫切除术式对子宫肌瘤患者生活质量的影响

目的探讨子宫全切除和次全切除两种术式对子宫肌瘤患者远期生活质量的影响。方法观察1998至2000年在本院行子宫切除术后3年以上，能配合调查的153例患者（手术组），其中行子宫全切术患者为97例（手术A组），行子宫次全切术为56例（手术B组），采取直接联系、问卷调查或电话随访等方式，对其术后生活质量及相关因素（生理、心理、妇科患病情况、社会因素及家庭关系）进行比较，并随机抽选同期在本院就诊而未行子宫切除术能配合调查的100例子宫肌瘤患者为对照组（研究经本院伦理学委员会批准，分组征得患者本人的知情同意）。对手术组和对照组患者让其接受本研究自行设计的《生活质量调查表》调查，以调查患者的心理状况、性生活质量、妇科疾病症状（阴道炎由阴道线索细胞、阴道pH值及胺试验结果确诊），并帮助其克服各种障碍，满足其健康需求和提高生活质量。结果手术A组与手术B组患者性生活质量比较，阴道线索细胞、阴道pH值及胺试验结果比较，差异均无显著意义（P〉0．05）；但手术组与对照组比较，差异有显著意义（P〈0．05）。手术A组患者虽然术后月经量增多、腹痛、异常阴道出血等子宫良性病变症状消失，但存在不同程度的身心问题，如潮热、失眠等。手术B组患者存在对术后残端癌变的恐惧和罹患宫颈疾病造成的精神压力。本研究结果提示，手术A组与手术B组接受的两种术式在性生活满意率、性欲下降率、性交疼痛发生率、耻骨尾骨肌强度、性生活中女方主动率、配偶性满意度方面比较，差异无显著意义。结论本研究对手术组综合比较显示，子宫切除术不同术式对患者远期性生活质量没有明显影响。手术前、后及时对患者进行指导，消除其心理障碍，手术组患者术后可完全恢复正常性生活。

Effects of Different Types of Hysterectomy on the Living Quality of Patients With Myoma of Uterus.

Objective To study the remote effects of different types of hysterectomy on patients＇ with myoma of uterus, and choose suitable style to improve patients＇ living quality. Methods From 1998 to 2000, 153 patients who suffered hysterectomy with at least 3 years followed-up were set as the operation group, including 97 patients with total hysterectomy （the group A） and 56 patients with subtotal hysterectomy（the group B）. Living quality and correlative factors （physiology, psychology, pathogenetic condition, social factors and family relationship ） after operation were compared by connection, questionnaire and follow-up visit by phone etc. 100 cases without hysterectomy were taken as the control group. Informed consent was obtained from all participants. All the subjects accepted Investigation of Quality of Life. Psychologic status, quality of sexual life and symptoms of gynecological disease were analyzed （Coleitis was diagnosed by vaginal clue cells, pH level and positive amine test）. Help patients to overcome disorders and meet their need in health. Results There were no significant differences in sexual life quality, vaginal clue cells, pH and positive amine test between the group A and the group B. But compared with the control group, the differences were significant. Although uterine benign lesion （menorrhagia, abnormal bellyache, colporrhagia,etc. ） disappeared after operation, physical and mental problems as hectic fever, agrypnia existed in the group A. Fear for stump cancer and cervix complaints existed in the group B. There were no significant differences in sexual life gratification degree, sexuality degression degree, dyspareunia rate, pubococcygeal muscle strength, female go-aheadism in sexual life and connubial sexual satisfaction between the group A and the group B. Conclusion General comparison indicated that total hysterectomy is better than subtotal hysterectomy in remote quality of life. Instructions and guidances to patients before and after operation will help them recover