早期宫颈癌广泛性子宫切除术疗效及术后并发症分析

目的分析早期宫颈癌行广泛性子宫切除术后并发症、疗效及技术改进要点。方法收集2000～2010年共378例行广泛性子宫切除术Ⅱb期以下早期宫颈癌患者的临床资料，分析术后并发症与5年生存率。结果本组患者术后总体并发症发生率为49．5％（187／378），其中淋巴囊肿93例（24．60％），尿潴留64例（16．93％），输尿管阴道瘘2例（0．52％），膀胱阴道瘘1例（0．26％），输尿管损伤1例（0．26％），伤口感染22例（5．82％），腹壁裂开3例（0．79％），髂血管损伤1例（0．26％）；随诊率为100％；5年存活率为89．9％，其中Ia期97．4％、Ib期91．1％、Ⅱa期88．3％及Ⅱb期72．2％；盆腔淋巴结无转移及有转移之5年存活率分别为92．7％及75．8％。结论广泛性子宫切除术后并发症与术中操作关系密切，改进相关技术要点将可能减少术后并发症发生率．提高疗效。

An analysis about the curative effect and postoperative complications of the radical hysterectomy adopted for early cerical cancer

Objective To analyze the postoperative complications,clinical curative effect of early cerical cancer patients who had underwent radical hysterectomy and technical improvement points.Methods The clinical data of 378 patients whose clinic period was lower than Ⅱb were collected from 2000 to 2010 after extensive hysterectomy,the incidence rate of the postoperative complication and 5-year survival rate were evaluated.Results The whole incidence rate of postoperative complications was 49.5%(187/378),including lymphocele(93 cases,24.60%),urinary remaination(64 cases,16.93%),ureteral-vaginal fistula(2 cases,0.52%),urinary bladder-vaginal fistula(1 case,0.26%),ureteral damage(1 cases,0.26%),and wound infection(22 cases,5.82%),abdominal wall burst(3 patients,0.79%),injury of iliac blood vessels(1 case,0.26%);The follow-up rate was 100%,the total 5-year survival rate 89.9%,with Ⅰa 97.4%,Ⅰb 91.1%,Ⅱa 88.3% and 72.2% phase Ⅱb;The 5-year survival rate of patients without pelvic lymph nodes transferring and with pelvic lymph nodes metastases respectively was 92.7% and 75.8%.Conclusion The incidence of complications after radical hysterectomy is close related with intraoperative performance;improving the relevant technical points may reduce the rate of postoperative complications,enhance the curative effect.