腹膜陰道延長術加心理干預對早期宮頸癌患者性生活及生命質量的影響

李亞琴 肖黎明 王慶霞

【摘要】目的：評估腹膜陰道延長術及心理干預對早期宮頸癌患者性生活質量及生活質量的影響。 方法：選擇2012年6月年至2014年6月的早期宮頸癌患者40例作為研究組，實施開腹廣泛子宮切除術加腹膜陰道延長術加盆腔淋巴結清掃術，輔以心理干預。選擇在同期住院的宮頸癌患者30例實施廣泛子宮切除術加盆腔淋巴結清掃術作為對照組。術后對性生活相關指標進行比較，并采用性生活和陰道變化（SVQ）問卷及Olson婚姻質量問卷對患者性生活狀態及生命質量進行評估，評價陰道延長及心理干預對早期宮頸癌患者性生活及生命質量的影響。結果：研究組與對照組在陰道長度、術后恢復規律性生活的時間、影響性生活的因素方面比較，差異有顯著性（P<0.05），而術后并發癥等方面差異無顯著性（P>0.05）。術后SVQ問卷提示兩組患者均存在陰道潤滑度降低、性交痛。而在自覺陰道太小而性交不適、因無性生活而不滿意、從未或很少在性生活后感到放松、性伴侶低性欲或無性欲、親密度、對自我形象不滿意等方面，兩者比較，差異有顯著性（P<0.05）。Olson婚姻質量問卷中夫妻交流、性生活、角色平等、婚姻滿意度4方面研究組與對照組比較，差異有顯著性（P<0.05）。結論：對早期宮頸癌患者實施陰道延長術，可延長患者陰道長度，加用心理干預，可明顯改善患者的性生活質量。臨床醫師在宮頸癌治療的過程中，應為患者實施陰道延長，并重視患者性生活的指導及心理狀態的干預。

【關鍵詞】宮頸癌；陰道延長；心理干預

【Abstract】Objectives： To evaluate the effect of vaginal lengthening of peritoneum and of psychological intervention on sexual life and quality of life for patients with the early cervical cancer. Methods： 40 patients of early-stage （Ib1-Ib2） cervical cancer were included in study group， who underwent vaginal extension following class radical hysterectomy （RH） and pelvic lymphadenecomy， and psychological intervention as well， while 30 patients with radical hysterectomy and pelvic lymphadenecomy only during the same period were allocated as control group. Case-control and Questionnaire-based method was employed in this study. Patients were assessed retrospectively by Sexual Function and Vaginal changes Questionnaire （SVQ） and Oslons marriage quality questionnaire mainly for quality of sexual life and sexual function as well as quality life at least 6 months after treatment. The key performance indicators of postoperative sexual life were analyzed and compared as well. Results： Postoperative vaginal length acquired by pelvic examination genecologic oncologists was （9.65±0.64）cm an（4.99±0.86）cm in the study group and the control group respectively （P<0.05）. 92.3%（36/39） of the cases in the study group and 63.3% （19/30） in the control group had resumed sexual activity， and the mean time interval between treatment and regular sexual activity was 6 months （range 2-6 months） and mean 6 months （range 4-16 months） in the study group and the control group respectively. Factors affecting sexual life were reduced in the study group， in which there was of significant difference， while there was no significant difference in postoperative complications between the study group and control group. Both groups presented with vaginal lubrication and painful sex. While the reduced vagina size and shorter vagina， low enjoyment or relaxation after sex， diminished sexual desire of sex partner， family cohesion， self-image satisfaction in the study group were more prominent than the control group with statistical significance （P< 0.05）. There was significant difference in that of the intercommunion of the couple， sexual life， equal role， satisfaction of marriage between the two groups （P<0.05） from the Oslonmarriage quality questionnaire. Conclusion： Early stage cervical cancer patients with vaginal lengthening， prolongs the vagina length， and combined with psychological intervention can significantly improve the quality of sexual life and psychological status of patients. In the course of treatment for cervical cancer， it is recommended that vaginal extension following RH should be performed with the guide of sexual life and psychological intervention.

【Key words】Cervical cancer； Vaginal lengthening； Psychological intervention

【中圖分類號】R737.33【文獻標志碼】A

宮頸癌是女性最常見的生殖器惡性腫瘤，研究表明宮頸癌的發病率近年來呈明顯上升趨勢，并逐漸趨向年輕化[1]。由于宮頸癌早期癥狀明顯，越來越多的宮頸癌在早期即被發現并接受規范治療，使得宮頸癌患者的生存期有了明顯延長。宮頸癌患者術后常存在較多不良心理反應，嚴重影響疾病的轉歸和預后，會嚴重加劇和影響到患者的生存質量[2]。……