宫颈癌患者卵巢移位术及阴道延长术后生理功能随访分析

目的:通过对早期宫颈癌患者自体卵巢移位术及阴道延长术后2年卵巢功能及性生活质量的随访,探讨卵巢移位术及阴道延长术的临床价值.方法:对45例宫颈癌患者,在行宫颈癌根治术同时行卵巢移位术和阴道延长术,术前、放疗后、术后6个月、术后1年、术后2年,行阴道细胞学检查、微粒子化学发光法血清性激素测定、B超检测、阴道长度测量,随访术后2年卵巢功能及性生活质量.结果:45例中有4例卵巢移位术后2年出现卵巢功能减退,保留卵巢功能的有效率为91.1%.同时行阴道延长术者共12例,随访至术后2年均性生活满意.未行阴道延长术的33例患者随访至术后2年,性生活欠满意27例,性生活困难6例.结论:宫颈癌患者根治术中行卵巢移位术加阴道延长术,可保留卵巢功能,提高患者术后性生活质量.     

腹腔镜下腹膜阴道延长术在早期子宫颈癌根治术中的应用

目的 探讨腹腔镜下腹膜阴道延长术在早期子宫颈癌根治术中的应用.方法 于2005-05-10对5例年轻早期宫颈癌（ⅠA2～ⅡA）患者行腹腔镜下腹膜阴道延长术,其中3例在腹腔镜下根治术同时行腹膜阴道延长术,2例因曾行宫颈癌根治术致阴道短缩而影响性生活行腹腔镜下腹膜阴道延长术.结果 5例手术均顺利完成.术后4周随访阴道黏膜光整、柔软、有弹性,阴道可容2指,阴道长度8～10cm;3例术后10～12周恢复性生活,性生活满意.结论 通过腹腔镜下腹膜阴道延长术,使宫颈癌根治术患者术后阴道有足够的长度,保证了术后性生活质量,但长期效果还有待观察.     

不同手术方式对宫颈癌患者术后生存质量的影响及对策

由手术造成的生理变化、相关的并发症及不同程度的精神心理问题等，严重影响了宫颈癌患者的术后生存质量。目前对生存质量的评价主要是采用一些标准化的量表。各种保留功能的手术方式使患者的生存质量得到很大改善，如保留盆腔自主神经广泛性子宫切除术、卵巢移位术、广泛性宫颈切除术、阴道延长术以及腹腔镜手术等。同时也应注重对患者有效的指导及完善的随访。     

宫颈周围韧带切除范围与术后近期膀胱功能障碍的相关性分析

目的:探讨宫颈周围韧带切除长度、宽度及阴道切除长度与术后近期膀胱功能障碍的相关性。方法:前瞻性研究2009年10月至2013年5月接受广泛性或次广泛性子宫切除术的宫颈癌或子宫内膜癌患者73例,术中测量切除标本的宫颈周围韧带切除长度、宽度及阴道前、后壁切除长度,术后记录留置尿管时间及最终残余尿量,术后3月接受下尿路及膀胱功能评估(MHU)量表调查及尿流动力学检查。并对宫颈周围韧带切除范围与术后近期膀胱功能障碍相关指标行Logistics回归单因素分析及多因素分析。结果:多因素分析示:1主观症状调查提示术后排尿困难、术后MHU量表评分与左侧阴道旁组织(PC)切除宽度呈正相关(P=0.008;P=0.028);2尿流动力学检查提示术后初始感觉膀胱容量与右侧PC切除宽度呈正相关(P=0.011),术后逼尿肌不稳定性与右侧骶子宫韧带(USL)切除宽度呈正相关(P=0.045)。结论:术后近期膀胱功能障碍的发生主要与术中USL及PC切除宽度相关,从而推测系统保留盆腔自主神经的广泛性子宫切除术的重点在于USL及PC的处理。     

阴道延长术在宫颈癌患者治疗中的意义

目的:探讨腹膜代阴道延长术在宫颈癌患者治疗中的意义。方法:16例ⅠB~ⅡA宫颈癌患者在行根治性手术的同时行腹膜阴道延长术,同期单纯根治性手术治疗的30例患者为对照组。结果:两组患者年龄、手术时间、术中出血量、住院时间、手术并发症差异无显著性(P>0.05),阴道延长组阴道长度、性生活满意度显著高于对照组(分别P=0.000,P=0.003)。结论:宫颈癌患者在行根治性手术治疗的同时行腹膜代阴道延长术可显著提高患者的生活质量,值得推广。     

广泛性子宫颈切除手术途径之探讨

广泛性子宫颈切除术（radical trachelectomy，RT）是一种可以保留患者生育能力的治疗早期子子宫颈癌的手术方式，该手术可以通过阴道、开腹或者腹腔镜来完成，但不同的手术途径适应证不同，对患者的肿瘤预后以及生育结局的影响不尽相同。对于早期子宫颈癌肿瘤直径＜2 cm的患者，3种手术途径具有相同的肿瘤预后，但是经阴道及腹腔镜子宫颈广泛切除的妊娠率明显高于开腹术后的妊娠率。对于肿瘤直径2～4 cm的患者，可以直接进行开腹子宫颈广泛切除，或者选择进行新辅助化疗待肿瘤直径缩小后进行经阴道或者腹腔镜子宫颈广泛切除同样也是安全有效的     

子宫广泛性切除加阴道全切除术中行子宫浆膜代阴道成形术治疗阴道黑色素瘤二例分析

阴道黑色素瘤是较罕见的妇科恶性肿瘤,病死率极高,目前尚无理想的治疗方案.清华大学玉泉医院分别于2005年和2007年对两例阴道黑色素瘤患者在子宫广泛性切除+阴道全切除术中行子宫浆膜代阴道成形术治疗.术后患者均恢复正常性生活,目前分别存活20和39个月.     

腹腔镜下保留盆腔神经的广泛性子宫切除术16例临床研究

目的:评估腹腔镜保留盆腔神经的广泛性子宫切除术的临床可行性,及其对膀胱与直肠功能的保护作用。方法:比较行LNSRH与腹腔镜下广泛性子宫切除术(LRH)的宫颈癌患者的术中及术后情况。结果:LNSRH组术后拔除尿管及首次排气时间短于LRH组(P=0.039,P=0.041);两组的手术时间、术中失血量、清扫盆腔淋巴结数、宫旁组织切除长度及阴道切除长度均无显著差异(P0.05)。结论:LNSRH可在达到治疗效果的基础上促进患者术后膀胱和直肠功能的快速恢复。     

机器人辅助广泛性子宫切除术和盆腔淋巴结切除术的初步研究

目的 探讨将机器人手术系统应用于宫颈癌的广泛性子宫切除+盆腔淋巴结切除术的可行性.方法 2008年12月-2009年8月,采用da Vinci机器人手术系统,对5例Ⅰb1～Ⅱ a期宫颈癌患者行机器人辅助广泛性子宫切除+盆腔淋巴结切除术.记录手术时间、术中出血量、术中及术后并发症的发生情况、手术前后血红蛋白含量变化、术后体温及排气时间、术后恢复自主排尿时间、术后住院时间、病理检查结果、盆腔淋巴结切除数等.结果 5例患者全部顺利完成手术,无中转开腹,无术中或术后并发症出现.5例患者的手术时间分别为305、365、275、240和245 min,平均为286 min;术中出血量分别约为200、400、650、300和400 ml,平均为390 ml.5例患者术后最高体温均未超过37.5℃,术后36 h均排气.5例患者术后住院时间分别为11、13、9、12和12 d,平均为11.4 d.5例患者的病理检查结果均为鳞状细胞癌,阴道残端和宫旁切缘均无残留病灶.盆腔淋巴结切除数分别为14、22、16、21和18个,平均为18.2个,淋巴结无转移.结论 机器人手术系统可以应用于宫颈癌的广泛性子宫切除+盆腔淋巴结切除术,这一新方法为宫颈癌的手术治疗提供了一个新的选择.     

宫颈癌根治术中腹膜代阴道临床分析

目的　探讨宫颈癌根治术中腹膜代阴道的临床价值。方法　前瞻性分析 15例Ⅰb～Ⅱa期病例 ,行广泛性子宫全切术同时行腹膜代阴道。取同期对照组 2 0例 ,未行腹膜代阴道。结果　此手术形成的阴道具有宽敞、光滑、湿润、弹性好等与正常阴道类似的生理功能 ,性生活满意。结论　年轻患者宫颈癌根治术中腹膜代阴道能有效地提高生活质量 ,值得临床推广。     

Sexual Function after Modified Radical Hysterectomy (Piver II/Type B) vs. Classic Radical Hysterectomy (Piver III/Type C2) for Early Stage Cervical Cancer. A Prospective Study

IntroductionWhen cervical cancer is detected at an early stage (International Federation of Gynecology and Obstetrics [FIGO] IA2‐IB1), it can be successfully treated by radical surgery alone. Considering that most patients are young and sexually active at the moment of diagnosis and the long life expectancy of survivors after the treatment, quality of life (QoL) and sexual function are important issues for cancer survivors and caregivers. However, only a few studies have examined the QoL and sexual function in disease‐free cervical cancer survivors, and there are no studies in the literature comparing prospectively sexual function after different types of radical hysterectomy.AimTo compare sexual function in two groups of early stage cervical cancer survivors treated by radical surgery alone, undergoing two different types of radical hysterectomy.MethodsPatients treated by radical hysterectomy with systematic lymphadenectomy for early stage cervical cancer (FIGO IA2‐IB1) have been enrolled and divided in two groups with regard to type of radical hysterectomy performed; S1: modified radical hysterectomy (Piver II/Type B), S2: classic radical hysterectomy (Piver III/ Type C2).Main Outcome MeasureTwenty‐four months after surgery we assessed the sexual function using the European Organization for Research and Treatment of Cancer Cervix Cancer Module Questionnaire, which is a validated system for the assessment of disease‐ and treatment‐specific issues that affect the QoL and sexual functioning of women who are treated for cervical cancer.ResultsOf the 31 patients enrolled in the S1 group and 46 in the S2 group, 23 and 33 patients have been included, respectively. We observed significant differences between the two groups in terms of symptom experience, sexual/vaginal functioning, sexual activity, and sexual enjoyment. There was not any significant difference regarding lymphedema, peripheral neuropathy, and sexual worry.ConclusionSurvivors of early stage cervical cancer treated by modified radical hysterectomy (Piver II/ Type B) have a better sexual function than those operated by classic radical hysterectomy (Piver III/ Type C2). Plotti F, Nelaj E, Sansone M, Antonelli E, Altavilla T, Angioli R, and Benedetti Panici P. Sexual function after modified radical hysterectomy (Piver II/Type B) vs. classic radical hysterectomy (Piver III/Type C2) for early stage cervical cancer: A prospective study. J Sex Med 2012;9:909–917.     

Is it necessary to make screening pap smears after hysterectomy?

OBJECTIVE: To precise the risk of cancer of the vagina after hysterectomy. PATIENTS AND METHODS: In our file of cervicovaginal and vulvar pathology, we looked for all VAIN and invasive cancers of the vagina on a 10-year period. RESULTS: Out of 2152 patients, we found but 45 cases, 13 of which only after total or radical hysterectomy: 4 cases of invasive cancer of the vagina (1 after radical hysterectomy for invasive cancer of the cervix, and 3 after total hysterectomy for CIN); 9 cases of VAIN (5 after total hysterectomy for CIN; and 4 VAIN (3 after radical hysterectomy for cervical invasion). DISCUSSION AND CONCLUSIONS: In our series, we did not observe precancerous or invasive lesion of the vagina after hysterectomy for benign lesion. Indeed, the 13 cases of invasive or in situ cancers of the vagina we found had undergone simple or radical hysterectomy for cervical lesion. We think that the cytological follow-up of the vaginal vault after hysterectomy for benign lesion can be, if not stopped, at least quite spaced out. On the other hand, the follow-up must be imperatively maintained in the event of hysterectomy for precancerous lesion or cancer of cervix.     

An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer

The objective of this study was to evaluate the problems with miction, defecation, and sexuality after a radical hysterectomy with or without adjuvant radiotherapy for the treatment of cervical cancer stage I-IIA. This study included an observational longitudinal study of self-reported bladder, defecation, and sexual problems with a baseline score. Ninety-four women were included in the study. An age-matched control group consisted of 224 women. The patients showed significantly more negative effects on sexual function compared with both the controls and their situation before the treatment throughout 24 months of follow-up. The problems included less lubrication, a narrow and short vagina, senseless areas around the labia, dyspareunia, and sexual dissatisfaction. Up to 12 months after the treatment, the patients complained significantly more of little or no urge to urinate and diarrhea as compared with the controls. Adjuvant radiotherapy did not increase the risk of bladder dysfunction, colorectal motility disorders, and sexual functions. We conclude that a radical hysterectomy for the treatment of early-stage cervical carcinoma is associated with adverse effects mainly on sexual functioning.     

保留盆腔自主神经广泛性子宫切除术疗效和安全性

保留盆腔自主神经广泛性子宫切除术的目的是在不影响宫颈癌治疗效果的同时，保留支配膀胱、直肠等器官的神经纤维，从而减少相关的术后并发症，改善患者的生活质量。文章阐述保留盆腔自主神经广泛性子宫切除术的疗效和安全性问题。     

Total laparoscopic radical hysterectomy using Lee-Huang portal and McCartney transvaginal tube

A surgical approach to the treatment of invasive cervical carcinoma 1b1 may result in decreased mortality and morbidity as well as better functional quality of life. Laparoscopic-assisted radical vaginal hysterectomy (LARVH) is an alternative treatment for early cervical cancer, with parts of the procedures performed vaginally. We modified LARVH to total laparoscopic radical hysterectomy (TLRH) using Lee-Huang portal and McCartney transvaginal tube. The advantage of TLRH for cervical cancer is that the entire procedure is performed under direct observation. It may reduce the possibility of visceral organ injury during vaginal procedures and could minimize vaginal bleeding due to dissection. The Lee-Huang portal as primary laparoscopic port affords wide access to the abdominal cavity and proper visual angle, and increases the working distance. A plastic McCartney transvaginal tube placed inside the vagina maintains pneumoperitoneum and performs a circular incision on the vagina around the uterus with ease. Our preliminary experience with 12 patients suggests that this method of TLRH is feasible for selected patients and may be a useful alternative in treating early cervical cancer.     

宫颈癌根治术中卵巢移位后卵巢功能的临床研究

目的:探讨宫颈癌根治术中卵巢移位对卵巢功能的影响。方法:回顾性分析2004年1月至2007年12月我院收治的早期宫颈癌31例,行广泛性全子宫切除+盆腔淋巴结清扫术同时行卵巢移位,术后随访患者有无绝经期症状,彩色多普勒超声监测卵巢形态、位置、大小、血供及盆腔情况,并行阴道脱落细胞学检查,测定血清中FSH、E2水平并行统计学分析,以判断术前、术后卵巢功能的改变情况。结果:31例患者卵巢移位后未出现绝经期症状;31例移位卵巢的大小,形态,血供均无异常,卵泡有周期性增大,无卵巢脱落;术后按常规行阴道细胞学检查无一例发现异常;术前、术后血激素水平差异无显著意义(P>0.05)。结论:卵巢移位不影响年轻宫颈癌患者卵巢功能。     

Objective assessment of sexual arousal in women with a history of hysterectomy

Objective   The potential contribution of psychological and anatomical changes to sexual dysfunction following hysterectomy is not clear. Radical hysterectomy for cervical cancer causes surgical damage to the autonomic nerves which are responsible for the increased vaginal blood flow during sexual arousal. Simple hysterectomy causes more limited nerve disruption. Photoplethysmographic assessment of vaginal pulse amplitude objectively measures vaginal blood flow during sexual arousal. We hypothesised that damage of the autonomic nerves results in a disrupted vaginal blood flow response during sexual stimulation.
Design   Between-groups comparison of vaginal pulse amplitude.
Setting   University hospital.
Sample   Twelve women with a history of radical hysterectomy, 12 women with a history of simple abdomonal hysterectomy and 17 aged-matched controls.
Methods   Photoplethysmographic assessment of vaginal pulse amplitude during sexual stimulation by erotic films. Self-reported ratings of subjective sexual arousal were collected after each erotic stimulus condition.
Main outcome measure   Maximum vaginal pulse amplitude.
Results   Maximum vaginal pulse amplitude differed between the three groups ( P = 0.043). Women with a history of radical hysterectomy had a lower response than controls ( P = 0.015). Women in the radical hysterectomy group and controls reported an equally strong subjective arousal. Women with a history of simple hysterectomy showed an intermediate maximum vaginal pulse amplitude.
Conclusions   Radical hysterectomy seems associated with a disturbed vaginal blood flow response during sexual arousal. This cannot be explained solely by uteric extirpation, since it was not observed to the same extent after simple hysterectomy, but might be related to a denervation of the vagina which increases with increasing radicality of surgery.     

Sexual functioning in patients following radical hysterectomy for stage IB cancer of the cervix

Abstract. Grumann M, Robertson R, Hacker NF, Sommer G. Sexual functioning in patients following radical hysterectomy for stage IB cancer of the cervix.
Despite extensive research on sexual dysfunction after gynecological cancer, uncertainty remains regarding the nature and extent of sexual problems following surgery for early cervical cancer. This study investigated whether radical hysterectomy for stage IB cancer of the cervix without adjuvant treatment entails short- or long-term sexual difficulties. Twenty patients with stage IB cervical cancer undergoing radical hysterectomy (CG), 18 women treated with hysterectomy for a benign gynecological condition (BG), and 20 gynecologically healthy women (HG) were studied. At 0, 4, and 8 months postoperatively, data were prospectively gathered using standardized questionnaires and specifically developed scales. Sexual functioning was covered in 15 specifically designed items and analyzed using Fisher's exact tests. For all other variables, group comparisons were computed using analysis of variance ( anova ) or nonparametric statistical equivalents. Nonsignificant trends, consistent across time and groups, resulted for most of the sexual variables. Preoperatively, cancer patients exhibited slightly better sexual functioning than the other two groups, but over time this decreased slightly. Conversely, sexual functioning among the patients with benign disease showed steady improvement. These results indicate that radical hysterectomy for stage IB cervical cancer does not entail major sexual sequelae. Because of the limited sample size of our study, conclusions must be drawn cautiously.     

Quality of Life and Sexual Function of Patients Following Radical Hysterectomy and Vaginal Extension

IntroductionRadical hysterectomy (RH) has negative consequences on sexual function due to a shortened vagina, vaginal dryness, and dyspareunia. Peritoneovaginoplasty aims to extend vagina by vesical peritoneum and anterior rectal wall to improve postoperative sexual function.AimThe aim of this study was to investigate whether vaginal extension can improve sexual function and quality of life and the problem of sexual dysfunction in early-stage cervical cancer survivors (CCSs) in China.MethodsCase-control and questionnaire-based methods were employed. Thirty-one patients who had undergone vaginal extension following RH and 28 patients with matching factors after RH alone were enrolled in the study.Main Outcome MeasuresBoth groups were assessed retrospectively by questionnaires at least 6 months after treatment. The European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire cervical cancer module and the Sexual Function Vaginal Changes Questionnaire are validated measurements for disease- and treatment-specific issues.ResultsVaginal length was 10.03 ± 1.26 cm and 5.92 ± 1.05 cm in study and control group, respectively (P< 0.05). In the study group, 67.7% patients and 64.3% of control group resumed sexual activity at the time of interview, averaging 6 months between treatment and sexual activity. While difficulty emptying bladder, incomplete emptying, and constipation were the most commonly reported symptoms, no significant difference was observed regarding pelvic floor symptoms. Reduced vagina size and shortened vagina was significantly more prominent in the control group, whereas both group presented with hypoactive sexual desire (88.1%), orgasm dysfunction (71.8%), and low enjoyment or relaxation after sex (51.3%).ConclusionShortened vagina was significantly less reported in study group, while no difference was observed in other sex-related dimensions. Vaginal extension does not worsen pelvic floor symptoms. Sexual rehabilitation interventions are of significance and should be paid more attention to the CCSs in China.Ye S, Yang J, Cao D, Zhu L, Lang J, Chuang LT, and Shen K. Quality of life and sexual function of patients following radical hysterectomy and vaginal extension. J Sex Med 2014;11:1334–1342.     

Laparoscopic abdominal radical trachelectomy

BACKGROUND: Radical trachelectomy is a fertility preserving alternative for young women with early stages of cervical cancer. Currently, a technique of abdominal radical approach is used in a few centres. With growing availability of laparoscopy, a novel technique of laparoscopic radical trachelectomy might be an alternative. CASE: Presented is one case of laparoscopic pelvic lymphadenectomy with radical trachelectomy in young woman with IB cervical cancer. No intraoperative or postoperative complications occurred. Operation time reached 250 min, estimated blood loss was 250 ml. Limited follow-up of 9 months was uneventful and patient indicates normal menstrual pattern and satisfactory sexual intercourse. CONCLUSION: Laparoscopic abdominal radical trachelectomy with pelvic lymphadenectomy might be an alternative technique in the treatment of early stages cervical cancer in patients who desire future pregnancy. The procedure is in principle identical to the standard abdominal radical hysterectomy. Centres practising laparoscopic radical hysterectomy can adopt the technique without any special surgical training.