宫颈癌术后盆底功能障碍非手术治疗研究进展

doi:10.3969/j.issn.1674-490X.2023.05.008

摘要/Abstract

摘要： 盆底功能障碍已成为宫颈癌术后常见的并发症,主要表现为膀胱功能障碍、直肠功能障碍、性功能障碍以及盆腔脏器脱垂等,严重影响患者的身心健康和生活质量,影响疾病预后。对宫颈癌术后患者进行早期的、专业的、个性化的盆底康复治疗会减少盆底功能障碍的发生、减轻盆底功能障碍的严重程度,目前对宫颈癌术后盆底功能障碍的非手术措施较多,现对其进行综述,以期为患者盆底功能康复、身心健康改善、生活质量提高提供依据。

关键词: 宫颈癌, 盆底功能障碍, 盆底康复

Abstract: Pelvic floor dysfunction has become a common post-operative complication of cervical cancer patients, mainly manifesting as bladder dysfunction, rectal dysfunction, sexual dysfunction and pelvic organ prolapse, which seriously affects patients' physical and mental health and quality of life, and affects the prognosis of the disease. Early, professional and personalized pelvic floor rehabilitation treatment for postoperative cervical cancer patients will reduce the occurrence and severity of pelvic floor dysfunction. There are many non-surgical measures for pelvic floor dysfunction after cervical cancer surgery. It is reviewed with a view to providing a basis for the rehabilitation of patients' pelvic floor function, improvement of their physical and mental health and quality of life.

Key words: cervical cancer, pelvic floor dysfunction, pelvic floor rehabilitation

中图分类号:

R473.73

李月,苏建萍. 宫颈癌术后盆底功能障碍非手术治疗研究进展[J]. 医学研究与教育, 2023, 40(5): 53-59.

参考文献

[1] SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660.
[2] COHEN P A, JHINGRAN A, OAKNIN A, et al. Cervical cancer[J]. Lancet, 2019, 393(10167): 169-182. DOI: 10.1016/s0140-6736(18)32470-x.
[3] LI M, TIAN Q. Risk factors for postoperative pelvic floor dysfunction in patients with cervical cancer: evidences for management strategies[J]. Transl Cancer Res, 2021, 10(10): 4338-4346. DOI: 10.21037/tcr-21-365.
[4] 李月,赖巧蓉,周娟,等.宫颈癌术后同步放化疗患者自我管理现状及其影响因素的研究[J].中国性科学, 2023, 32(4): 59-62. DOI: 10.3969/j.issn.1672-1993.2023.04.014.
[5] MIGUEL T P, LAURIENZO C E, FARIA E F, et al. Chemoradiation for cervical cancer treatment portends high risk of pelvic floor dysfunction[J]. PLoS One, 2020, 15(6): e0234389. DOI: 10.1371/journal.pone.0234389.
[6] WANG S Y, WANG R Z, WEN H W, et al. Association of pelvic floor function with postoperative urinary incontinence in cervical cancer patients after the radical hysterectomy[J]. Neurourol Urodyn, 2021, 40(1): 483-492. DOI: 10.1002/nau.24587.
[7] FONTENELE M Q S, MOREIRA M A, MOURA A C R, et al. Pelvic floor dysfunction distress is correlated with quality of life, but not with muscle function[J].Arch Gynecol Obstet, 2021, 303(1): 143-149. DOI: 10.1007/s00404-020-05770-5.
[8] 唐玲玲,李力.子宫颈癌术后远期盆底功能障碍问卷调查及对生活质量的分析研究[J].实用妇产科杂志, 2021, 37(6): 447-451.
[9] 陈庆,张欣,谢秀英.女性盆底功能障碍康复训练研究进展[J].陕西医学杂志, 2020, 49(11): 1531-1533. DOI: 10.3969/j.issn.1000-7377.2020.11.042.
[10] 王惠琴,马娟文,马明妍,等.女性盆底功能障碍性疾病的研究进展[J].实用妇科内分泌电子杂志, 2019, 6(32): 17-18, 24. DOI: 10.16484/j.cnki.issn2095-8803.2019.32.010.
[11] LAI Y T, LIN A W, ZHENG Z H, et al. Perceptions of pelvic floor dysfunction and rehabilitation care amongst women in southeast China after radical hysterectomy: a qualitative study[J]. BMC Womens Health, 2022, 22(1): 108. DOI: 10.1186/s12905-022-01687-0.
[12] 靳翠平,尚玉敏,胡同秀,等.盆底肌电在产后盆底功能障碍性疾病诊断和治疗中的价值[J].中国现代医学杂志, 2021, 31(1): 62-67. DOI: 10.3969/j.issn.1005-8982.2021.01.011.
[13] 孙秀丽,王建六.盆底康复在宫颈癌术后的应用[J].实用妇产科杂志, 2017, 33(7): 488-489. DOI: 10.3969/j.issn.1001-1242.2012.08.024.
[14] 杨雪晴.健康行为改变整合理论在早期宫颈癌术后合并盆底功能障碍性疾病患者盆底肌锻炼中的应用研究[D].无锡:江南大学, 2020:1-2.
[15] KEGEL A H. Progressive resistance exercise in the functional restoration of the perineal muscles[J]. Am J Obstet Gynecol, 1948, 56(2): 238-248. DOI: 10.1016/0002-9378(48)90266-x.
[16] 徐璐茜.健康行为互动模式在早期宫颈癌术后合并盆底功能障碍性疾病患者盆底康复中的应用研究[D].无锡:江南大学, 2021:3-4.
[17] 符云.盆底功能锻炼在宫颈癌患者术后尿潴留预防中的应用效果[J].医疗装备, 2020, 33(18): 166-167. DOI: 10.3969/j.issn.1002-2376.2020.18.100.
[18] 张含,冯素文.宫颈癌根治术后患者盆底功能障碍性疾病临床表现及康复策略的研究进展[J].护理与康复, 2019, 18(7): 34-37. DOI: 10.3969/j.issn.1671-9875.2019.07.009.
[19] BRENNEN R, LIN K Y, DENEHY L, et al. The effect of pelvic floor muscle interventions on pelvic floor dysfunction after gynecological cancer treatment: a systematic review[J]. Phys Ther, 2020, 100(8): 1357-1371. DOI: 10.1093/ptj/pzaa081.
[20] 袁书琪,王园园,贾凌莹,等.癌因性疲乏患者瑜伽运动管理的最佳证据总结[J].中华护理杂志, 2023, 58(1): 91-97. DOI: 10.3761/j.issn.0254-1769.2023.01.013.
[21] 王珊.盆底肌瑜伽对宫颈癌根治术后患者膀胱功能及生命质量影响的研究[D].南昌:南昌大学, 2020:21-25.
[22] 于香.盆底肌瑜伽练习对腹腔镜下宫颈癌根治术尿潴留及盆底肌功能影响研究[J].中国医药指南, 2023, 21(9): 97-99. DOI: 10.15912/j.cnki.gocm.2023.09.018.
[23] 吴艳玲,张小凤.盆底肌瑜伽在子宫附件切除术后盆底功能障碍患者中的应用效果[J].临床医学研究与实践, 2022, 7(5): 174-177. DOI: 10.19347/j.cnki.2096-1413.202205051.
[24] COLEMAN T J, NYGAARD I E, HOLDER D N, et al. Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm[J]. Int Urogynecol J, 2015, 26(8): 1123-1130. DOI: 10.1007/s00192-015-2638-4.
[25] CHMIELEWSKA D, STANIA M, KUCAB-KLICH K, et al. Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises[J]. PLoS One, 2019, 14(12): e0225647. DOI: 10.1371/journal.pone.0225647.
[26] DE MARCHI T, FERLITO J V, TURRA A C, et al. Pilates method and/or photobiomodulation therapy combined to static magnetic field in women with stress urinary incontinence: a randomized, double-blind, placebo-controlled clinical trial[J]. J Clin Med, 2023, 12(3): 1104. DOI: 10.3390/jcm12031104.
[27] 樊周能,陈雅婷.普拉提联合盆底肌训练应用于宫颈癌根治术后患者的疗效观察[J].中医外治杂志, 2022, 31(4): 56-57. DOI: 10.3969/j.issn.1006-978X.2022.04.026.
[28] 张珂,胡青,谢臻蔚.女性盆底康复的方法及技术[J].实用妇产科杂志, 2017, 33(7): 482-485. DOI: 10.1016/j.juro.2016.11.091.
[29] 张冬梅.温针结合生物电刺激对子宫脱垂盆底功能影响的临床研究[D]. 昆明:云南中医药大学, 2020:37-38.
[30] 柴国娣,崔洪银,沈敏燕.阴道哑铃训练联合配偶支持在腹腔镜子宫全切术后盆底功能障碍患者护理中的应用[J].中国性科学, 2022, 31(11): 80-83. DOI: 10.3969/j.issn.1672-1993.2022.11.020.
[31] LI H, ZHOU C K, SONG J, et al. Curative efficacy of low frequency electrical stimulation in preventing urinary retention after cervical cancer operation[J]. World J Surg Oncol, 2019, 17(1): 141. DOI: 10.1186/s12957-019-1689-2.
[32] SUN X L, WANG H B, WANG Z Q, et al. Effect of transcutaneous electrical stimulation treatment on lower urinary tract symptoms after class III radical hysterectomy in cervical cancer patients: study protocol for a multicentre, randomized controlled trial[J]. BMC Cancer, 2017, 17(1): 416. DOI: 10.1186/s12885-017-3387-1.
[33] 占惠鸣,石祖妹,钱方芳,等.低频电刺激在预防宫颈癌术后尿潴留中的应用[J].临床和实验医学杂志, 2020, 19(3): 326-328. DOI: 10.3969/j.issn.1671-4695.2020.03.030.
[34] LI X W, GAO L, WANG Q, et al. Long-term effect of early post-operative transcutaneous electrical stimulation on voiding function after radical hysterectomy: a multicenter, randomized, controlled trial[J]. Front Med(Lausanne), 2021, 8: 677029. DOI: 10.3389/fmed.2021.677029.
[35] 李建华,王楚怀,刘宏亮,等.盆底功能障碍性疾病诊治与康复(康复分册)[M].杭州:浙江大学出版社, 2020:228-230.
[36] 张靖,杨茹,白惠娟.生物反馈训练结合间歇性夹管对宫颈癌患者术后疼痛、膀胱功能及并发症的影响[J].郑州大学学报(医学版), 2022, 57(2): 266-270. DOI: 10.13705/j.issn.1671-6825.2021.07.033.
[37] CYR M P, DUMOULIN C, BESSETTE P, et al. Feasibility, acceptability and effects of multimodal pelvic floor physical therapy for gynecological cancer survivors suffering from painful sexual intercourse: a multicenter prospective interventional study[J]. Gynecol Oncol, 2020, 159(3): 778-784. DOI: 10.1016/j.ygyno.2020.09.001.
[38] 田婧,谭建媛.不同时机盆底康复治疗对宫颈癌PiverⅢ型子宫切除术患者术后盆底功能的影响[J].现代肿瘤医学, 2023, 31(1): 156-160. DOI: 10.3969/j.issn.1672-4992.2023.01.029.
[39] 吴洁,袁梦,陈伟,等.盆底磁刺激治疗初产妇产后性功能障碍的临床研究[J].中国康复医学杂志, 2022, 37(3): 385-388. DOI: 10.3969/j.issn.1001-1242.2022.03.018.
[40] 罗瑞.肌电刺激对产后盆底功能障碍患者尿失禁发生及盆底功能的影响[J].实用医药杂志, 2019, 36(2): 141-142. DOI: 10.14172/j.issn1671-4008.2019.02.016.
[41] YAMANISHI T, SUZUKI T, SATO R, et al. Effects of magnetic stimulation on urodynamic stress incontinence refractory to pelvic floor muscle training in a randomized sham-controlled study[J]. Low Urin Tract Symptoms, 2019, 11(1): 61-65. DOI: 10.1111/luts.12197.
[42] 金绍兰,贺潇月.盆底磁刺激联合生物反馈治疗盆底失弛缓型便秘30例疗效观察[J].中国肛肠病杂志, 2021, 41(9): 51-53. DOI: 10.3969/j.issn.1000-1174.2021.09.024.
[43] 曹耀萍,高丹,陈艳.核心肌群稳定性训练联合生物反馈在早期宫颈癌根治术后患者盆底康复中的应用[J].中华现代护理杂志, 2022, 28(3): 362-365. DOI: 10.3760/cma.j.cn115682-20210714-03138.
[44] ZONG J J, YOU M H, LI C. Effect of Kegel pelvic floor muscle exercise combined with clean intermittent self-catheterization on urinary retention after radical hysterectomy for cervical cancer[J]. Pak J Med Sci, 2022, 38(3Part-I): 462-468. DOI: 10.12669/pjms.38.3.4495.
[45] 邢晶.盆底肌瑜伽训练联合清洁间歇性导尿术对宫颈癌根治术后患者膀胱功能的影响[J].反射疗法与康复医学, 2022, 3(8): 91-94.
[46] 吴琼,孙静莉.腹腔镜下全子宫切除术后盆底康复疗法临床效果[J].创伤与急危重病医学, 2022, 10(6): 455-456, 460. DOI: 10.16048/j.issn.2095-5561.2022.06.18.
[47] 宋曙霞,王雄虎,何田田,等.腹针联合中药治疗产后盆底功能障碍临床研究[J]. 新中医, 2019, 51(8): 211-214. DOI: 10.13457/j.cnki.jncm.2019.08.063.
[48] 汪汐,龙子临,何欣,等.基于数据挖掘分析针灸改善宫颈癌术后尿潴留的选穴规律[J].针灸临床杂志, 2022, 38(11): 39-43. DOI: 10.19917/j.cnki.1005-0779.022209.
[49] ZHAO Q Y, YAN C C, DAN M, et al. Efficacy and safety of acupuncture for urinary retention after hysterectomy: a systematic review and meta-analysis[J]. Medicine(Baltimore), 2021, 100(22): e26064. DOI: 10.1097/MD.0000000000026064.
[50] 谢芬,张泓,周艳华,等.电针结合运动想象疗法对宫颈癌术后尿潴留患者尿动力学及生活质量的影响研究[J].湖南中医药大学学报, 2023, 43(4): 712-717. DOI: 10.3969/j.issn.1674-070X.2023.04.022.
[51] 庞文涛.穴位按摩对宫颈癌术后患者膀胱功能恢复的效果观察[J].中国保健营养, 2018, 28(23): 31-32. DOI: 10.3969/j.issn.1004-7484.2018.23.038.
[52] 王敏,马玉珍.中医多途径特色护理方案对宫颈癌根治术后患者胃肠及膀胱功能恢复的影响[J].青海医药杂志, 2022, 52(1): 35-38. DOI: 10.3969/j.issn.1672-9455.2020.04.002.
[53] 仇静波,朱玮,刘莹.妊娠晚期女性盆底功能障碍性疾病发生率及知识水平调查[J].中国妇幼保健, 2019, 34(7): 1636-1638. DOI: 10.7620/zgfybj.j.issn.1001-4411.2019.07.59.
[54] 李春映,王璐,朱蓝玉.社区护士健康教育能力的研究现状[J].职业与健康, 2022, 38(9): 1287-1290. DOI: 10.13329/j.cnki.zyyjk.2022.0238.
[55] 魏晚霞,李君芳,刘东星.微信平台健康教育在宫颈癌术后携尿管出院患者延续护理中的应用效果[J].当代医学, 2019, 25(26): 99-101. DOI: 10.3969/j.issn.1009-4393.2019.26.041.
[56] 张蓉,余欣梅,王琼,等.正念冥想训练联合盆底肌训练对早期宫颈癌患者术后的影响[J].检验医学与临床, 2020, 17(1): 35-38, 42. DOI: 10.3969/j.issn.1672-9455.2020.01.009.
[57] 付静文,张璠,张未.腰椎全麻手术患者术后排尿功能障碍的危险因素分析[J].实用医院临床杂志, 2020, 17(5): 10-12. DOI: 10.3969/j.issn.1672-6170.2020.05.003.