247例子宫颈癌根治术的并发症分析

背景与目的:手术是治疗早期宫颈癌的主要手段,术前辅助放疗及化疗能提高手术切除率,改善手术质量.本文回顾性分析宫颈癌根治术后的并发症及其相关因素,探讨其防治措施,以减少并发症,提高患者生活质量.材料与方法:收集2000年1月至2006年12月间经病理证实且资料完整的子宫颈癌患者247例,所有病例均行子宫颈癌根治术(广泛性子官切除术加盆腔淋巴结清扫术),根据病情130例行术前腔内放疗,其中52例患者在术前腔内放疗同时行一个疗程化疗. 结果:247例手术并发症主要为尿潴留,淋巴囊肿,泌尿系感染,发生率分别为24.7%、7.69%、8.50%.术前辅助放疗和(或)化疗者与术前无辅助治疗的上述3种手术并发症发生率分别为23.1%/26.5%、6.93%/8.55%、10.77%/5.99%,差异均无统计学意义(P均＞0.05).247例患者术中平均出血量约(470 ±37.45)ml,术前辅助放疗和(或)化疗者与术前无辅助治疗术中平均出血量分别为(490.74±47.67)ral及(438±61.38)ml,差异无统计学意义(P均＞0.05). 结论:宫颈癌根治术后并发症主要为尿潴留,淋巴囊肿,泌尿系感染.术前辅助腔内后装放疗及化疗不增加手术出血量以及术后并发症.     

宫颈癌根治术后并发症分析

目的 探讨宫颈癌根治术后并发症的发生及防治.方法 210例宫颈癌患者行广泛性子宫全切+盆腔淋巴结清扫术,并分析其并发症发生情况及防治方法.结果 全组210例中,54例发生手术并发症(25.71％),主要为尿潴留、淋巴囊肿、静脉血栓、泌尿系感染、腹部切口感染.结论 严格掌握手术指征,术中操作认真,加强术后护理,及早发现并处理并发症的诱因,能够减少手术并发症.     

39例早期宫颈癌根治术的并发症分析

目的：分析宫颈癌根治术的并发症及降低并发症的方法。方法：39例早期宫颈癌行广泛性子宫切除术加盆腔淋巴结清扫术,其中临床分期ⅠA期4例,占10.25%;ⅠB期23例,占58.97%;ⅡA期12例,占30.76%。鳞癌34例,占87.18%,腺癌和腺鳞癌5例,占12.82%。结果：发生手术并发症9例,发生率为23.07%。手术并发症主要为尿潴留、淋巴囊肿、腹部伤口感染,发生率分别为15.38%、12.82%、5.12%。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。     

39例早期宫颈癌根治术的并发症分析

目的:分析宫颈癌根治术的并发症及降低并发症的方法。方法:39例早期宫颈癌行广泛性子宫切除术加盆腔淋巴结清扫术,其中临床分期ⅠA期4例,占10.25%;ⅠB期23例,占58.97%;ⅡA期12例,占30.76%。鳞癌34例,占87.18%,腺癌和腺鳞癌5例,占12.82%。结果:发生手术并发症9例,发生率为23.07%。手术并发症主要为尿潴留、淋巴囊肿、腹部伤口感染,发生率分别为15.38%、12.82%、5.12%。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。     

降低宫颈癌根治术后并发症的技术改进

目的：探讨降低宫颈癌根术后尿潴留、尿瘘及泌尿道感染的发生。方法：对110例早期宫颈癌患者，在实施盆腔根治术的同时，作了输尿管悬吊、部分阴道重建和膀胱造瘘术。结果：术后无1例发生尿瘘，术后泌尿道感染发生率为16.36%(18/110），术后膀胱功能在14天内恢复正常者占45.45%(50/110），14天以上者占54.54%(60/110）。阴道重建术后病例的平均阴道和长度为8.54cm。与对照组相比，上述方法能显著降低术后尿瘘及泌尿道感染发病率，并能有效长阴道长度和缩短住院时间。结论：上述方法是降低宫颈癌术后并发症的有效措施，具有良好的临床应用前景。     

宫颈癌根治术腹腔镜与开腹手术的临床对照研究

目的 对比宫颈癌根治术腹腔镜与开腹手术的疗效及安全性.方法 选取60例宫颈癌患者,随机分为2组.对照组(30例)采用开腹手术进行治疗,观察组(30例)采用腹腔镜下宫颈癌根治术.观察并记录2组围手术期指标,切除范围,术后24 h、1个月、3个月的VAS评分及随访3个月期间并发症发生情况,评价2种手术方法的疗效及安全性.结果 观察组患者手术时间长于对照组患者,但术中出血量少于对照组(P<0.05),排气时间也短于对照组(P<0.05);2组淋巴结清扫数目、术后留置尿管时间相比,无统计学差异(P>0.05);2组切除范围相比,无统计学差异(P>0.05).术后24 h内,2组VAS评分相比,无统计学差异(P>0.05);术后1个月、3个月,观察组VAS评分低于对照组(P<0.05).随访3个月期间,观察组总并发症发生率26.7%,显著低于对照组的53.3%(P<0.05).结论 腹腔镜下宫颈癌根治术对宫颈癌具有较好的治疗效果,手术创伤小,对内脏器官干扰小,术后疼痛感轻,并发症少,值得临床推广.     

宫颈癌根治术后常见并发症的护理

宫颈癌是妇女中常见的恶性肿瘤。手术是早期子宫颈癌主要的治疗手段之一。由于宫颈癌根治术手术范围广、创面大 ,涉及盆腔诸多脏器 ,术中损伤以及术后的并发症时有发生。为了提高手术疗效 ,减少并发症 ,我们针对性的采取了相应预防护理措施 ,得到了较好的效果 ,现将体会报告如下。1　临床资料我院从 1990年～ 2 0 0 2年行宫颈癌根治术 2 77例。年龄2 2～ 6 5岁 ,平均年龄 4 8岁。其中Ⅰa期 2 7例 ,Ⅱa期 81例 ,Ⅱb期 119例 ,鳞癌 2 5 3例 ,腺癌 2 4例。 2 77例均行广泛全子宫切除术及盆腔淋巴结清扫术。2　泌尿系统并发症广泛性全子宫切除术…     

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。     

在宫颈癌根治术中后腹膜开放与关闭的术后并发症对照研究

目的：分析宫颈癌根治术后的后腹膜关闭与否对患者术后并发症的影响。方法：回顾分析2006年1月至2008年12月期间,汕头大学医学院附属肿瘤医院收治的260例行子宫广泛切除并盆腔淋巴结清扫术的宫颈癌患者,其中开放后腹膜组115例,关闭后腹膜组145例,对比2组在手术时间、术后淋巴囊肿形成、下肢淋巴回流障碍或静脉血栓形成出现的下肢肿胀以及肠梗阻发生的差异。结果：开放后腹膜组手术时间明显短于关闭后腹膜组（P〈0.05）;开放后腹膜组患者术后盆腔淋巴囊肿发生率明显低于关闭后腹膜组（P〈0.05）;开放后腹膜组术后因淋巴回流障碍或静脉血栓形成出现下肢肿胀的发生率明显低于关闭后腹膜组（P〈0.05）;术后发生肠梗阻的情况2组间的差异无统计学意义（P〉0.05）。结论：宫颈癌根治术行盆腔淋巴结清扫后开放后腹膜可缩短手术时间,并且可减少术后并发症的发生。     

200例子宫颈癌患者手术后并发症的观察及护理

子宫颈癌是女性生殖系统常见恶性肿瘤，是发生在全球妇女中仅次于乳腺癌的第2个最常见肿瘤。其病因大多数与以下因素有关：性行为及婚产史、避孕方法、宫颈糜烂、病毒因素、吸烟、职业等方面。临床主要表现为：接触性阴道流血、白带增多、大小便改变、腰腹及骶髂部疼痛、贫血、恶病质等表现。根据子宫颈癌侵犯的范围，临床大致可分以下几期：0期：原位癌；Ⅰ期：癌瘤仅局限于子宫颈；Ⅱ期：癌瘤已浸润阴道（未超过下1／3）及宫旁组织（未达盆腔）；Ⅲ期：癌瘤已侵犯阴道下部1／3，或延及盆壁；Ⅳ期：癌瘤延及膀胱及直肠，或转移至骨盆以外器官。     

Incidence and predictors of febrile morbidity after radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer patients

This study was undertaken to evaluate the incidence and independent predictors for febrile morbidity after radical hysterectomy and pelvic lymphadenectomy. Patients with FIGO stage IB-IIA cervical cancers who had undergone RHPL at Chiang Mai University Hospital between January 2003 and December 2005, were reviewed. The clinical variables including the age at diagnosis, menopausal status, body mass index, previous cervical conization, tumor size, preoperative chemotherapy, preoperative anemia, operative time, and estimated blood loss were analyzed for prediction of postoperative febrile morbidity. During the study period, 357 women were reviewed. The mean age was 44.7 years. Sixty-five (18.2%) women were postmenopausal. The majority of women (77.3%) were in FIGO stage IB1. The most common histology was squamous cell carcinoma (69.2%). Febrile morbidity was noted in 94 women (26.3%, 95% CI= 21.8-31.2) in whom 25 (7.0%) had urinary tract infection (19), abdominal wound infection (4), and vaginal cuff infection (2), respectively. Only massive blood loss (>1,500 ml) was noted as the significantly independent predictor for febrile morbidity (aOR= 2.7, 95% CI=1.1-6.6, P=0.028). In conclusion, approximately one-fourth of the women undergoing RHPL at our institute had postoperative febrile morbidity. Only massive blood loss is a significant predictor for this complication.     

Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in patients with Ib1 stage cervical cancer: Analysis of surgical and oncological outcome

Aim

To evaluate safety, feasibility and oncological outcome of total laparoscopic radical hysterectomy (TLRH) in patients with early invasive cervical cancer.

Methods

Data of patients with Ib1 cervical cancer who underwent TLRH were prospectively collected. Inclusion criteria were: good general condition, tumor size <3 cm, and no evidence of lymph node metastases in imaging study (MRI and/or CT and/or PET). Radical hysterectomy was performed with a PlasmaKinetic tissue management system. Adjuvant therapy was administered according to surgical risk factors.

Results

Between September 2001 and October 2007 107 patients underwent laparoscopic radical hysterectomy and pelvic lymphadenectomy. Conversion to laparotomy was necessary in 6 patients. Median number of resected pelvic lymph nodes was 26. Median blood loss was 200 ml and median duration of surgery was 305 min. Minor intraoperative complications were registered in two patients, while five patients needed a second surgery for postoperative complications. Thirteen patients had microscopic nodal metastasis. A total of 24 patients received adjuvant therapy. After a median follow-up of 30 months 11 patients had a recurrence; survival rate is 95%.

Conclusion

Total laparoscopic radical hysterectomy, in experienced hands, has to be considerate an adequate and feasible surgical technique. Considering historical data the oncological outcome can be considered comparable to patients treated with laparotomy, as the relapse rate in our population was 11% and the overall survival good.     

腹腔镜在早期宫颈癌根治术中的应用效果评价

目的 探讨腹腔镜手术治疗早期宫颈癌的可行性、安全性及临床价值。方法 收集2009年1月至2014年12月在广西医科大学附属肿瘤医院妇瘤科行宫颈癌根治术的623例早期宫颈癌患者的病历资料,按手术方式分组：腹腔镜组374例,开腹组249例。回顾性分析两组患者的基本情况、手术时间、术中出血量、术中淋巴结切除数目、宫旁组织及阴道切除长度及手术并发症。结果 腹腔镜手术组成功实施368例,成功率98.40％（368／374）,中转开腹6例,中转开腹率1.60％ （6／374）。腹腔镜组在手术时间、术中出血量、术后下床活动时间、肛门排气时间均优于开腹组,差异均有统计学意义（P＜0.05）,而两组淋巴结切除数、宫旁组织和阴道切除长度比较,差异均无统计学意义（P＞0.05）。在术中及术后并发症方面,除尿潴留外,两组差异均无统计学意义（P＞0.05）。结论 腹腔镜下宫颈癌根治术较传统开腹手术创伤小、术中出血量少、术后并发症少及术后恢复快,是治疗早期宫颈癌有效、安全的方法。     

Prevalence and characteristics of late postoperative voiding dysfunction in early-stage cervical cancer patients treated with radical hysterectomy.

BACKGROUND: Although effective as a primary treatment for early-stage cervical cancer, radical hysterectomy is associated with significant long-term morbidities, most commonly, voiding dysfunction. OBJECTIVE: To examine prevalence and characteristics of voiding dysfunction following radical hysterectomy for early-stage cervical cancer. METHODS: One hundred-eighty seven patients with FIGO stage IA2-IIA cervical cancer who underwent class II-III radical hysterectomy with systematic pelvic lymphadenectomy between January 1, 2002 and June 31, 2005 were interviewed with questionnaire on voiding function. Medical records were also reviewed for operative and pathologic data. RESULTS: The prevalence of symptomatic bladder dysfunction was 25.1%. There was no statistically significant association between rates of bladder dysfunction and all examined clinical/operative factors. The most common pattern of bladder dysfunction were incomplete emptying in 25 (13.4%) and urgency and nocturia in 21 (11.2%) each. CONCLUSION: Voiding dysfunction is a common and clinically significant long-term complication following radical hysterectomy. The pattern of dysfunction reflects combined surgical disruption of both parasympathetic and sympathetic innervations of the pelvis.     

保留盆腔自主神经的根治性子宫切除术治疗宫颈癌的临床研究

目的　探讨保留盆腔自主神经的根治性子宫切除术（ＮＳＲＨ）治疗宫颈癌的临床疗效及技术上的可行性。方法　选择我院２００８年４月至２００９年１０月ＦＩＧＯ分期为ⅠＢ～ⅡＢ的子宫颈癌患者６９例,研究组（ｎ＝３３）采用ＮＳＲＨ,对照组（ｎ＝３６）为传统的Ｐｉｖｅｒ-ＲｕｔｌｅｄｇｅⅢ型宫颈癌根治术ＲＨ,比较两组术后膀胱和直肠功能的恢复情况以及手术时间、术中出血量和手术切除范围。结果　研究组与对照组相比,术后残余尿＜１００ｍｌ的平均时间分别为（１２.６４±４.４９）ｄ和（１７.８９±４.１９）ｄ,术后残余尿＜５０ｍｌ的平均时间分别为（１４.３０±５.８７）ｄ和（１９.６９±４.４８）ｄ,术后肛门排气时间分别为（６２.９９±１１.９９）ｈ和（７９.３２±１３.２２）ｈ,术后排便时间分别为（９５.４２±１２.５４）ｈ和（１２０.０４±２１.００）ｈ,组间比较差异有统计学意义（Ｐ＜０.００１）。部分患者术后尿流动力学的测定结果显示,在膀胱灌注阶段和排尿阶段两组结果均有差异（Ｐ＜０.０５）。研究组与对照组总手术时间中位数分别为２５２ｍｉｎ（１８０～３３０ｍｉｎ）和２０５ｍｉｎ（１５０～２７０ｍｉｎ）,子宫切除时间中位数为８９ｍｉｎ（６５～１０５ｍｉｎ）和７０ｍｉｎ（５５～９０ｍｉｎ）,差异有统计学意义（Ｐ＜０.０５）。主、骶韧带和阴道切除的长度及术中出血量两组无显著性差异。结论　保留盆腔自主神经的根治性子宫切除术具有可行性和安全性,有利于术后膀胱、直肠功能的恢复。     

Treatment of cervical carcinoma by total hysterectomy and postoperative external irradiation

The survival rates of 36 patients with early cervical carcinoma who had undergone total hysterectomy and bilateral salpingoophorectomy (THBSO) were compared to the survival rates of 41 patients who were subjected to the radical operation. As an integral part of their therapy both groups postoperatively received adequate doses of external beam supervoltage irradiation. Satisfactory results were obtained in both groups of patients. According to these results THBSO followed by postoperative radiotherapy is adequate treatment for early cervical carcinoma. In comparison to the radical operation or curietherapy alone this type of treatment has the advantage of requiring less surgical or radiotherapeutic expertise; it probably is associated with less morbidity.     

Sexual morbidity following radical hysterectomy for cervical cancer

Radical hysterectomy for early stage cervical cancer has satisfactory results in terms of survival, but may impact negatively on a patient’s quality of life, which may include sexual dysfunctions. Female sexual dysfunctions (FSD) represent a frequent morbidity but often remain unrecognized and undertreated. Although discussions regarding sexuality are found by many medical doctors to be sensitive and embarrassing, psychosexual counseling is an essential component of comprehensive care for gynecological cancer patients and their partners. The goal of this article is to summarize and discuss available relevant data on FSD in women who have undergone radical hysterectomy for an early stage of cervical cancer.     

Minilaparoscopic radical hysterectomy for cervical cancer: Multi-institutional experience in comparison with conventional laparoscopy

Objective

To analyze the preliminary experience of three gynecologic oncology services with minilaparoscopic radical hysterectomy (mLRH) for the treatment of cervical cancer and to compare perioperative outcomes with those of conventional laparoscopic surgery (LRH).

Methods

Prospectively collected data on consecutive cervical cancer patients undergoing radical hysterectomy with a laparoscopic approach were analyzed retrospectively. Perioperative outcomes of women undergoing mLRH were compared to data from control patients who had undergone LRH with 5-mm instruments. Adjustment for potential selection bias in surgical approach was made with propensity score (PS) matching.

Results

The study cohort consisted of 257 patients, 35 undergoing mLRH and 222 undergoing LRH. The two groups were comparable in terms of demographic and tumor characteristics. No significant differences were observed between groups in terms of operative time, blood loss, lymph node yield, amount of parametrial or vaginal cuff tissue removed, and percentage of intra- or postoperative complications, both in the entire cohort and in the PS matched group. No conversions were needed from mLRH to standard laparoscopy or from minilaparoscopy to open surgery. Conversion from standard laparoscopy to open surgery was necessary in 2 patients. A shorter hospital stay was observed among women who had mLRH than in those undergoing LRH [2 (1–10) vs 4 (1–14) days, p = 0.005]. This difference remained significant after PS matching.

Conclusion

Our preliminary study suggests that in experienced hands minilaparoscopy is a feasible and safe technique for radical hysterectomy and yields results that are equivalent to those of LRH.     

Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer

Objective

To compare the efficacy of neoadjuvant chemotherapy with paclitaxel plus platinum followed by radical hysterectomy with radical surgery alone in patients with stage IB2-IIA bulky cervical cancer.

Methods

From November 1999 to September 2007, stage IB2-IIA cervical cancers with tumor diameter >4 cm, as measured by MRI, were managed with two cycles of preoperative paclitaxel and platinum. As a control group, we selected 35 patients treated with radical surgery alone.

Results

There were no significant between group differences in age, tumor size, FIGO stage, level of SCC Ag, histopathologic type and grade. Operating time, estimated blood loss, the number of lymph nodes yielded and the rate of complications were similar in the two groups. In surgical specimens, lymph-vascular space invasion (LVSI), nodal metastasis and parametrial involvement did not differ significantly between the two groups. In the neoadjuvant group, pathologic tumor size was significantly smaller and fewer patients had deep cervical invasion. Radiotherapy, alone and in the form of concurrent chemoradiation, was administered to more patients treated with radical surgery alone (82.9% vs. 52.9%, p=0.006). No recurrence was observed in patients who could avoid adjuvant radiotherapy owing to improved risk factors after neoadjuvant chemotherapy. There were no significant differences in 5-year disease free and overall survival.

Conclusion

As neoadjuvant chemotherapy would improve pathologic prognostic factors, adjuvant radiotherapy can be avoided, without worsening the prognosis, in patients with locally advanced bulky cervical cancer. Neoadjuvant chemotherapy would be improving the quality of life after radical hysterectomy in patients with bulky cervical cancer.