530例宫颈癌根治术后近期并发症分析

[目的]探讨宫颈癌根治术术中、术后并发症情况及其相关影响因素。[方法]2000年1月至2009年12月经病理证实资料完整的530例宫颈癌患者,均行宫颈癌根治＋盆腔淋巴结清扫术,其中200例术前行新辅助化疗。观察术中、术后并发症发生情况及术前化疗对并发症的影响。[结果]530例患者术中并发症以出血、输尿管损伤为主,术后并发症以尿潴留、淋巴囊肿、泌尿系统感染为主。新辅助化疗的患者术中、术后并发症发生情况与未行化疗者比较无统计学差异（P〉0.05）。[结论]宫颈癌根治术并发症发生率较高,且术前有无辅助化疗对宫颈癌根治术术中、术后并发症的发生无明显影响。     

综合性护理联合控尿功能训练对宫颈癌根治术后患者生活质量及膀胱功能的影响

目的探讨综合性护理联合控尿功能训练对宫颈癌根治术后患者生活质量及膀胱功能的影响。方法选取2014年8月至2016年2月间西安交通大学医学院附属广仁医院收治的103例行宫颈癌根治术的患者,采用随机数表法分为观察组和对照组,观察组52例,对照组51例。观察组患者予以综合性护理联合控尿功能训练,对照组患者行常规护理。比较两组患者治疗后的膀胱功能变化情况,对两组患者6个月后的生活质量进行比较。结果观察组患者治疗后的残余尿量、尿潴留率和再置管率均低于对照组患者,且自解小便率高于对照组患者,差异均有统计学意义(均P<0.05)。观察组患者治疗后的膀胱功能优于对照组患者,差异有统计学意义(P<0.05)。观察组功能领域内的角色功能、认知功能、躯体功能、情绪功能及社会功能评分均高于对照组,差异均有统计学意义(均P<0.05)。观察组症状领域中的疼痛、疲劳及恶性呕吐评分低于对照组,差异均有统计学意义(均P<0.05)。观察组单一症状领域中的食欲减退、失眠、气短、腹泻、便秘及经济困难评分均低于对照组,差异均有统计学意义(均P<0.05)。观察组总体生活质量量表评分高于对照组,差异有统计学意义(P<0.05)。结论综合性护理联合控尿功能训练可明显提高宫颈癌根治术后患者的生活质量,促进膀胱功能的恢复,最终改善宫颈癌患者的预后。     

膀胱穿刺造瘘术100例宫颈癌根治术应用分析

[目的]探讨膀胱穿刺造瘘术降低宫颈癌根治术后尿潴留、泌尿道感染等并发症作用。[方法]随机选取2006年10月至2008年3月200例实施宫颈癌根治术的早期宫颈癌患者,其中100例行膀胱穿刺造瘘术为研究组,另外100例经尿道留置尿管为对照组,比较两组尿潴留、尿路感染发生率。[结果]研究组尿潴留发生率和泌尿道感染发生率均比对照组显著性降低(34%vs62%,χ2=15.705,P=0.0001;10%vs32%,χ2=14.5871,P=0.001)。[结论]膀胱穿刺造瘘术降低术后尿潴留及泌尿道感染的发生率,具有良好的临床应用价值。     

宫颈癌根治术中开放阴道断端的意义

[目的]探讨开放阴道断端在宫颈癌根治术巾的意义。[方法]选取宫颈癌根治术患者138例，根据阴道断端的开放或闭合分为两组（A组，开放组65例；B组，闭合组73例）。比较两组术后康复情况及术后3个月阴道残端的长度。[结果]A、B两组平均术后发热时间为5．45d与5．95d（P=0．24）：平均术后拔除腹腔引流管时间均为5．51d；发生阴道残端或（及）盆腔感染分别为4／65例（6．2％）与7／73例（9．6％）（P=0．46），以上三组数据均无统计学差异。但是A组淋巴囊肿发生率高于B组（29．2％vs．13．7％，P=0．025）。术后3个月门诊复查，A组患者的阴道平均长度6．82±0．61cm，而B组为5．11±0．39cm（P〈0．01）。[结沦]开放或闭合阴道断端对宫颈癌根治术后的近期康复影响无显著差异，但开放阴道断端可以明显增加阴道残端长度，改善术后性生活质量。开放阴道断端对年轻宫颈癌患者更有意义。     

121例宫颈癌根治术近期并发症分析

[目的]探讨广泛性子宫切除术治疗宫颈癌的术后近期并发症及降低并发症的方法.[方法]121例宫颈癌行广泛性子宫切除术,其中临床分期Ⅰ a期19例,Ⅰ b期62例,Ⅱa期34例,Ⅱb期6例.其中宫颈鳞癌111例(91.7%),其它类型10例(8.3%).[结果]常见的近期手术并发症为泌尿系统并发症,术后泌尿系统感染发生率为12.4%,尿潴留发生率为9.1%.腓深静脉血栓发生率为2.5%而无股静脉血栓、尿瘘、盆腔感染发生.[结论]熟悉盆腔解剖,提高手术熟练程度,术中仔细操作,术后使用广谱抗生素,加强护理,及早发现并处理并发症的前兆表现,可以降低手术并发症的发生率.     

系统保留盆腔自主神经的广泛性子宫切除术对宫颈癌患者尿流动力学的影响

摘 要：［目的］ 探讨系统保留盆腔自主神经的广泛性子宫切除术对宫颈癌患者术后近期及远期尿流动力学的影响。［方法］ 92例早期宫颈癌患者随机分为两组,观察组46例行系统保留盆腔自主神经的广泛性子宫切除术,对照组46例行传统的广泛性子宫切除术,比较两组术前、术后1个月、术后12个月的尿流动力学相关指标。［结果］ 观察组和对照组术前最大尿流率（MFR）、最大逼尿肌收缩压（MPdet）、膀胱顺应性分别为27.4±4.3ml/s、44.3±9.8cm H2O、103.6±59.8ml/cm H2O和27.7±4.9ml/s、43.7±8.9cm H2O、104.9±60.9ml/cm H2O;两组术后1个月上述指标分别为20.4±3.0ml/s、29.7±5.4cm H2O、55.8±49.2ml/cm H2O和12.0±5.6ml/s、19.5±7.3cm H2O、30.1±14.7ml/cm H2O,均较术前低（P均＜0.05）;两组术后12个月上述指标分别为25.9±4.8ml/s、42.5±9.3cm H2O、96.1±56.7ml/cm H2O和19.3±3.8ml/s、30.1±7.7cm H2O、79.2±44.1ml/cm H2O,均有一定程度恢复,其中观察组恢复至术前水平（P均>0.05）,而对照组尚低于术前（P均＜0.05）。观察组和对照组术前膀胱残余尿量分别为10.2±3.8ml和8.2±4.5ml;两组术后1个月分别为86.1±10.8ml和196.9±74.2 ml,均较术前高（P均＜0.05）;两组术后12个月分别为20.2±8.6 ml和65.7±20.0 ml,均有一定程度恢复,但对照组仍高于术前（P均＜0.05）。两组术前MFR、MPdet、膀胱顺应性、膀胱残余尿量比较差异均无统计学意义（P均>0.05）。观察组术后1个月、12个月的MFR、MPdet、膀胱顺应性均高于对照组（P均＜0.05）;而膀胱残余尿量低于对照组（P均＜0.05）。［结论］ 系统保留盆腔自主神经的广泛性子宫切除术对宫颈癌患者术后尿流动力学影响相对较小,尤其是远期膀胱功能恢复方面有明显优势,可明显改善患者的生活质量。     

放疗后近期子宫切除治疗局部晚期宫颈部

探讨局部晚期宫颈癌能否通过全量或近全量放疗后补充子宫切除术,提高局部控制率。２４例宫颈癌,平均年龄４０岁,病理证实腺癌７例,鳞癌１７例按ＦＩＧＯ分期Ⅱｂ１７例,Ⅲｂ７ｗｇｑ ;ｐｋ ａｄｍｋｇｆ ｓｃｅｈｇａｊｆａｋ ｄ大型,直径均大于４ｃｍ;术前行常规综合放疗。     

170例宫颈癌根治术后并发症分析

对我院1995年至1998年170例宫颈癌根治术后发生的并发症进行分析。结果示盆腔淋巴囊肿,尿潴留,腹壁切口感染,输尿管瘘,下肢静脉栓塞,阴道断端出血为宫颈癌根治术后主要的并发症。     

宫颈癌全子宫切除术后的心理护理

子宫颈癌是妇科恶性肿瘤中最常见的一种。子宫颈癌的发病率在女性肿瘤中居第1,患者好发于35～39岁和60～64岁,年龄分布呈双峰状,平均年龄为52.2岁,病死率居女性肿瘤的第4位。子宫切除是一种常见手术,多数女性认为子宫切除后会改变内分泌、影响性生活,从而对手术     

宫颈癌患者根治手术后尿潴留的预防效果分析

目的探讨宫颈癌根治术后尿潴留的预防措施及其效果。方法选取2011年1月至2013年12月间收治的行宫颈癌根治术的患者168例,随机分为观察组和对照组,每组84例。观察组患者接受系统护理干预,对照组患者接受常规治疗和护理,比较两组患者的尿潴留预防效果。结果观察组患者术后尿管留置时间和残余尿量均明显少于对照组,差异有统计学意义(P<0.05)。观察组患者术后尿潴留发生率为4.8%,对照组患者术后尿潴留发生率为23.8%,差异有统计学意义(P<0.05)。结论对宫颈癌根治术后患者实施系统护理干预配合膀胱冲洗等治疗性护理措施,可有效预防术后尿潴留的发生,明显改善患者术后生活质量,值得在临床推广应用。     

Nerve-preserving techniques for radical hysterectomy

AIMS: Postoperative bladder dysfunction of varying severity is common after radical hysterectomy due to damage to the pelvic autonomic nerves during surgical resection. Pelvic autonomic nerve damage occurs at two main sites: the fibrous tissue at the lateral aspect of the uterosacral ligament (FLUSL) and the posterior layer of the vesicouterine ligament (PLVUL). In this article, we classify the main sites of pelvic autonomic nerve damage based on previous reports and our own experience, outline the problems with current nerve-preserving techniques, and describe an improved nerve-preserving technique that we have developed. RESULTS: We present urodynamic data for 25 patients who underwent radical hysterectomy using the nerve-preserving technique we described previously and preliminary results for four patients treated by the latest technique. To avoid pelvic autonomic nerve damage, injury to the FLUSL and PLVUL should be minimized. For the FLUSL, we have obtained relatively good bladder function with the cardinal ligament pull-through technique. However, a new method is needed for management of the PLVUL, since the only way to minimize nerve damage at this site currently is to limit the extent of PLVUL resection.     

Risk factors for and delayed recognition of genitourinary fistula following radical hysterectomy for cervical cancer: a population-based analysis

ObjectiveThis study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer.MethodsThis study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004–2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal–Wallis test.ResultsIn this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women’s and children’s hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040).ConclusionIntraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF.     

根治性子宫切除术中保留盆腔自主神经的初步研究

目的 探讨保留盆腔自主神经的根治性子宫切除术(NSRH)的技术要点及可行性,评价其改善子宫颈癌患者术后膀胱功能的作用.方法 选择42例拟行根治性子官切除加盆腔淋巴结清扫术的Ⅰ b1～Ⅰ b2期子宫颈鳞癌患者,研究组(21例)行NSRH,对照组(21例)行常规根治性子宫切除术,比较两组手术时间、失血量及术后留置尿管的时间.采用免疫组化SP法,检测两组患者手术切除的宫骶韧带和主韧带切缘中S-100蛋白的表达,比较两组神经含量的差异.结果 研究组和对照组患者的手术时间分别为(248±24)min和(227±27)min,差异有统计学意义(P<0.01).研究组和对照组患者的术中失血量分别为(459±143)ml和(454±121)ml,差异无统计学意义(P>0.05).研究组和对照组患者术后尿管留置的中位时间分别为7 d和16 d,差异有统计学意义(P<0.01).术后7 d,研究组和对照组残余尿量≤100 ml的患者所占的比例分别为66.7%和19.0%,差异有统计学意义(P<0.01).两组患者均未发生严重的并发症,术后中位随访14个月(11～16个月),无一例患者出现复发转移.S-100免疫组化检测结果 显示,常规根治性子宫切除的切缘中含有大量神经束,而NSRH切缘中仅含有较少的神经纤维,两组相比,差异有统计学意义(P<0.01).结论 NSRH治疗早期子宫颈癌是可行和安全的,能减少手术过程中对盆腔自主神经的损伤程度,降低患者术后尿潴留的发生率.     

Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial

Objective

A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer.

Methods

From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively.

Results

There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups.

Conclusion

NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.     

保留一侧或两侧盆腔神经的广泛性子宫切除术治疗宫颈癌的可行性及其术后膀胱和肠功能恢复的评价

目的 初步探讨保留一侧或两侧盆腔神经的广泛性子官切除术的可行性和对术后膀胱直肠功能恢复的评估.方法 选择2008年8月至2009年10月浙江省肿瘤医院妇瘤科收治的61例Ⅰb1～Ⅱa期子宫颈癌患者,其中28例行保留盆腔神经的子宫广泛性切除术(NSRH),33例行传统的子宫广泛性切除术(RH).NSRH组中,有10例患者行保留一侧盆腔神经手术(UNSRH),18例患者行保留两侧盆腔神经手术(BNSRH).分别监测NSRH和RH的手术时间、手术出血量及术后并发症,观察手术对膀胱和直肠功能恢复的影响.结果 NSRH组的手术时间、手术出血量、术后住院时间和残余尿量分别为(224.5±40.0)min、(464.3±144.0)ml、(8.4±2.0)d和(64.8±16.9)ml,RH组分别为(176.4±30.0)min、(374.2±138.7)ml、(9.2±1.8)d和(70.6±16.0)ml,差异均无统计学意义(均P>0.05).UNSRH组的手术时间、手术出血量、术后住院时间和残余尿量分别为(208.5±28.5)min、(440.0±104.9)ml、(9.1±1.8)d、(68.3±12.5)ml,BNSRH组分别为(233.3±43.1)min、(477.8±162.9)ml、(8.7±2.1)d和(62.8±20.0)ml,两组差异均无统计学意义(均P>0.05).NSRH组术后留置膀胱造痿管时间为(12.4±5.2)d,RH组为(22.4±9.7)d,差异有统计学意义(P<0.05).BNSRH组术后留置膀胱造瘘管时间为(9.1±2.0)d,UNSRH组为(18.2±3.6)d,差异有统计学意义(P<0.05).术后3周,NSRH组的排尿和排便满意度分别为100%和75.0%,RH组分别为54.5%和24.2%,差异均有统计学意义(均P<0.05).结论 保留一侧或两侧盆腔自主神经的广泛性子宫切除术对治疗早期宫颈癌是安全可行的,此手术方式能有效地改善术后膀胱功能及直肠功能恢复.

Abstract：

Objective To investigate the feasibility of unilateral or bilateral nerve-sparing radical hysterectomy and evaluate the recovery of bladder and bowel function postoperatively.Methods From August 2008 to October 2009, sixty-one patients with cervical cancer stage Ⅰ b1 to Ⅱ a underwent radical hysterectomy ( 33 cases) and nerve-sparing radical hysterectomy ( 28 cases).Unilateral nerve-sparing radical hysterectomy was performed in 10 patients, and bilateral nerve-sparing radical hysterectomy (BNS) was performed in 18 patients.The data of operation time, blood loss, postoperative hospital stay days, residual urine volume, and postoperative complications were collected.The postoperative recovery of bladder and bowel function was evaluated.Results There were no significant differences between nerve-sparing radical hysterectomy (NSRH) and radical hysterectomy ( RH ) groups in operation time [NSRH:( 224.5±40.0 )min,RH:(176.4 ±30.0 min)], blood loss [NSRH:(464.3±144.0) mi,RH:(374.2±138.7) ml],postoperative hospital stay days [NSRH:(8.4 ± 2.0 ) d, RH:(9.2 ± 1.8 ) d, and residual urine volume [NSRH:(64.8 ± 16.9) mi, RH:(70.6 ± 16.0) ml].There were also no significant differences betweenUNSRH and BNSRH groups in operation time [UNSRH:(208.5±28.5 ) min, BNSRH:(233.3±43.1 )min], blood loss [UNSRH:(440.0±104.9) ml, BNSRH:( 477.8±62.90) ml], postoperative hospital stay days [UNSRH:9.1±1.8) d, BNSRH:(8.7±2.1d], and the residual urine volume [UNSRH:(68.3±12.5) ml, BNSRH:(62.8±20.0) ml].There was a significant difference in the time of the Foley catheter removal between NSRH [( 12.4±5.2) d] and RH [(22.4 ± 9.7 ) d] groups.There was a significant difference in the time of the Foley catheter removal between UNSRH [( 18.2±3.6) d] and BNSRH [(9.1±2.0)d] groups.During the postoperative 3 weeks follow-up, the patients in the NSRH group had a higher rate of satisfaction at urination and defecation ( 100%, 75% ) than the RH group (54.5%,24.2% ).Conclusion UNSRH and BNSRH are safe and feasible techniques for early stage cervical cancer, and may significantly improve the recovery of bladder and rectal function.     

宫颈癌根治手术440例分析

目的:探讨宫颈癌根治术的手术情况.方法:对440例行宫颈癌根治术患者的临床及手术情况进行回顾性分析.结果:患者的平均年龄为43.9岁(范围:21～78岁),体质量指数的均数为23.2(范围:15.8～47.3)kg/m2.患者病理类型为:鳞癌353例(80.2%),腺癌56例(12.7%),腺鳞癌20例(4.6%),其他病理类型11例(2.5%).根据国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期标准:Ⅰ期患者314例(71.4%),Ⅱ期126例(28.6%).手术平均时间为221 min(范围:90～410 min),术中平均出血量为697 mL(范围:80～2 300mL).有148例患者接受了输血,平均输血量为825 mL(200～2 300 mL).87例(19.8%)患者术后病理提示淋巴结转移,淋巴转移的平均数为2.1个(1～5个),而脉管内转移的患者为83例(18.9%).患者平均住院时间为26 d(9～57 d).术后有并发症发生的为145例患者(32.9%):包括尿潴留、伤口感染、淋巴囊肿、深静脉血栓,其中残余尿量＞100 mL者为125例,术后发热患者为73例.结论:本院施行的宫颈癌根治手术在宫颈癌治疗方面取得了较好的疗效.     

The incidence of urologic complications requiring urologic procedure in radical hysterectomy and difference between abdominal radical hysterectomy and laparoscopic radical hysterectomy

ObjectiveTo evaluate the incidence of urologic complications requiring a urologic procedure during the perioperative period and compare the differences between abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH).MethodsWe identified all Korean women who underwent radical hysterectomy (RH) between January 2006 and December 2019 using the National Health Insurance Service database. Complications requiring surgical intervention-based urologic procedures between ARH and LRH were investigated.ResultsA total of 12,068 patients were classified into the ARH group and 8,837 patients were classified into the LRH group. Urologic complications requiring urologic procedures occurred in 1,546 of 20,905 patients (7.40%) who underwent RH. The most common urologic procedure was double-J insertion (R326, 5.18%), followed by bladder repair (R3550, 0.90%). There was no significant difference in urologic complications requiring urologic procedures between the ARH and LRH groups (odds ratio [OR]=1.027; 95% confidence interval [CI]=0.925–1.141; p=0.612). The incidence of bladder repair (R3550) was significantly higher in patients who underwent LRH (OR=1.620; 95% CI=1.220–2.171; p<0.001). Urologic complications requiring urologic procedures were statistically higher in the LRH group during the first half (OR=1.446; 95% CI=1.240–1.685; p<0.001), but more in the ARH group during the second half (OR=0.696; 95% CI=0.602–0.804; p<0.001) of the study period.ConclusionThere was no difference of urologic complications between ARH and LRH with regard to urologic procedures. The incidence of urologic procedures decreases with time in patients who underwent LRH.     

根治性膀胱全切术后正位可控膀胱术研究进展.

 正位膀胱替代术经过近20 年的临床实践，被越来越多的医学中心所采用。通过总结重要的文献阐述了正位可控膀胱术中患者的选择、输尿管抗反流、上尿路安全性、尿控的恢复、肿瘤治疗的安全性、特殊的并发症和患者生存生活质量等方面的最新进展和新观点。与其他方式的尿流改道相比，正位可控膀胱有可能成为根治性膀胱全切术后新的治疗标准