腹腔镜保留神经的广泛子宫切除术治疗宫颈癌临床分析

目的:探讨腹腔镜保留神经的广泛子宫切除术治疗宫颈癌的可行性及临床价值。方法:自2008年3月~2009年8月郑州大学第三附属医院对17例Ⅰa~Ⅱa期宫颈癌患者行腹腔镜保留神经的广泛子宫切除术,同传统腹腔镜下非保留神经手术对比,分析两组手术时间、术中出血量、手术范围及术后患者膀胱、直肠功能恢复情况。结果:17例患者中2例因出血较多保留单侧神经,1例为Ⅱa期选择性保留病灶对侧盆腔神经,余成功保留双侧神经。保留组手术时间明显延长(P<0.05),排气时间、留置尿管时间显著缩短(P<0.05),术中出血量、切除宫旁组织宽度差异无统计学意义(P>0.05)。术后3个月随访,保留组患者膀胱、直肠功能明显优于非保留组。结论:腹腔镜保留神经的广泛子宫切除术治疗宫颈癌具有可行性,不影响手术范围,初步证明其有利于保护患者膀胱、直肠功能。

Clinical analysis on nerve -sparing laparoscopy radical hysterectomy in treatment of cervical cancer

Objective:To explore the feasibility and clinical value of nerve-sparing laparoscopy radical hysterectomy in treatment of cervical cancer.Methods:17 cases with cervical cancer of Ⅰa~Ⅱa stage in the hospital from March 2008 to August 2009 received nerve-sparing laparoscopy radical hysterectomy;the operation time,the amount of intraoperative blood loss,the scope of operation,recovery of postoperative bladder and rectal function were compared with those of cases receiving routine non-nerve-sparing laparoscopy radical hysterectomy.Results:Among 17 cases,2 cases reserved unilateral nerve because of massive hemorrhage,1 case of Ⅱa stage reserved contralateral pelvic nerve of focus,and the other cases reserved bilateral nerves successfully;the operation time of study group was longer than that of control group(P<0.05),the evacuation time and indwelling catheter time in study group were shorter than those in control group(P<0.05),there was no significant difference in the amount of intraoperative blood loss and the scope of operation between the two groups(P>0.05);after follow-up for three months,the bladder and rectal function in study group were superior to those in control group.Conclusion:Nerve-sparing laparoscopy radical hysterectomy is feasible in treatment of cervical cancer,which does not affect the scope of operation,and it is helpful to protect bladder and rectal function.