腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析

Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.

Laparoscopic anatomical nerve sparing radical hysterectomy for cervical cancer: a clinical analysis of 37 cases