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目的研究全膀胱切除及尿流改道术后影响男性患者性功能障碍的相关因素。方法对2004年1月至2014年6月行膀胱全切及尿流改道术男性患者112例,采用国际勃起功能(IIEF-5)评分、国际尿控协会问卷的简短版本(ICIQ-SF)评分、焦虑自评量表(SAS)、抑郁自评量表(SDS)、自制性高潮功能障碍问卷,进行回顾性调查。并应用Logistic回归进行多因素分析。结果(1)发放120份问卷,回收112份,回收率为93.3%,其中有性生活的82例患者纳入本研究。(2)以年龄分组,勃起功能障碍(ED)发病率为28.6%~81.8%,性高潮功能障碍(OA)发病率为23.8%~72.7%。性高潮功能障碍具体发病情况,14.6%患者无性高潮,57.3%患者高潮强度降低,性生活开始至性高潮时间增加发生率为52.4%。(3)患者的ED与年龄、体质量指数、ICIQ-SF评分、焦虑、血管神经保留有关,OA与年龄、体质量指数、ICIQ-SF评分、焦虑、血管神经保留有关。(4)多因素Logistic回归分析,年龄是ED、OA共同危险因素,神经保留、术前ED是ED的危险因素,高ICIQ-SF评分(16~21分)是OA的危险因素。结论性功能障碍是全膀胱切除及尿流改道术后患者常见并发症,临床医生应注意筛查其影响因素有年龄、神经保留、术前ED、高ICIQ-SF评分。
Objective To study the factors that affect the sexual dysfunction in men after total cystectomy and urinary diversion. Methods A total of 112 male patients undergoing total cystectomy and urinary diversion from January 2004 to June 2014 were enrolled in this study. The scores of IIEF-5, ICIQ-SF , Self-rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Self-made Orgasm Disorder Questionnaire were retrospectively reviewed. Logistic regression was used for multivariate analysis. Results (1) 120 questionnaires were distributed and 112 were recovered with a recovery rate of 93.3%. Among them, 82 patients with sexual life were included in this study. (2) According to the age group, the incidence of erectile dysfunction (ED) was 28.6% -81.8%, and the incidence of orgasmic dysfunction (OA) was 23.8% -72.7%. The specific incidence of orgasmic dysfunction, 14.6% of patients with orgasm, 57.3% of patients with decreased intensity of the tide, sex life to the onset of orgasm time was 52.4%. (3) The ED of patients was related to age, body mass index, ICIQ-SF score, anxiety and vascular nerve retention. OA was related to age, body mass index, ICIQ-SF score, anxiety and vascular nerve retention. (4) Multivariate logistic regression analysis showed that age was a common risk factor of ED and OA, nerve retention and preoperative ED were risk factors of ED. High ICIQ-SF score (16-21) was a risk factor for OA. Conclusions Sexual dysfunction is a common complication of patients undergoing total cystectomy and urinary diversion. Clinicians should pay attention to screening for influencing factors such as age, nerve retention, preoperative ED, and high ICIQ-SF score.