腹腔镜下系统保留盆腔自主神经的广泛性子宫切除术治疗早期宫颈癌38例

目的探讨腹腔镜下系统保留盆腔自主神经的广泛性子宫切除术(LSNSRH)治疗早期宫颈癌的临床疗效,并评价术后膀胱、直肠功能的恢复效果。方法选择2008年3月至2009年5月收治的ⅠA2~ⅡA期宫颈癌患者81例,研究组38例采用LSNSRH,对照组43例行腹腔镜下广泛性子宫切除术(LRH)。比较两组的手术时间、术中出血量、切除淋巴结数量、宫旁组织和阴道切除长度、手术并发症、术后住院时间及膀胱、直肠功能的恢复情况。结果两组患者均在腹腔镜下顺利完成手术。(1)LSNSRH组在术中出血量、切除淋巴结数量及宫颈旁组织、阴道切除长度和LRH组比较差异无统计学意义(P>0.05),而手术时间长于LRH组(P<0.05),术后住院时间少于LRH组(P<0.05)。(2)两组患者均未发生手术并发症。术后病理检查提示,所有患者宫颈旁均无肿瘤侵犯,也无淋巴结转移。两组患者随访15~29个月,所有患者健在,均无复发和转移。(3)LSNSRH组术后拔除尿管的平均时间、术后残余尿量小于或等于50 mL的平均时间、尿流动力学结果(尿道闭合压、最大膀胱容量和最大尿流率)、术后肛门排气及排便时间与LRH组相比,差异有统计学意义。结论采用LSNSRH治疗早期宫颈癌具有可行性和安全性,有利于术后膀胱、直肠功能的恢复。

Laparoscopic systematic nerve-sparing radical hysterectomy for early cervical cancer: a clinical research of 38 cases

Objective To investigate the clinical effects and the impact on bladder and rectal function of laparoscopic systematic nerve-sparing radical hysterectomy for cervical cancer.Methods Between March 2008 and May 2009,38 patients underwent laparoscopic systematic nerve-sparing radical hysterectomy(LSNSRH) with pelvic lymphadenectomy for early cervical cancer,and compared with 43 consecutive laparoscopic type Ⅲ radical hysterectomy(LRH) with pelvic lymphadenectomy.The mean operation time,the quantity of mean intraoperative blood loss,numbers of pelvic lymph nodes resected,extent of parametrium and vagina resection,postoperative complications,duration of postoperative hospital stay and the bladder and rectum function after the operation were compared between the two groups.Results The laparoscopic systematic nerve-sparing procedure was completed successfully and safely in all of the patients.1.No significant differences were observed in terms of mean operation time,the quantity of mean intraoperative blood loss,numbers of pelvic lymph nodes resected,extent of parametrium and vagina resection between the two groups.However,the duration of postoperative hospital stay was better in the LSNSRH group.2.There were no postoperative complications in all patients.No one patients had recurrence and metastasis.All patients were followed up for 15-29 months and no patient died.3.The LSNSRH group showed a significant reduction in the mean time of catheter removed,the time to achieve a postvoid residual urine volume less than 50 mL,the first exhaust time and the first stool time compared with the LRH group.Moreover,the closing urethral pressure,maximum bladder capacity and peak flow rate were all significantly higher in the LSNSRH group.Conclusion LSNSRH is a safe and feasible technique which can be conducive to bladder and rectum function recovery.