腹腔镜下系统保留盆腔自主神经的广泛性子宫切除术的比较研究

目的探讨腹腔镜下广泛性子宫切除术（laparoscopic radical hysterectomy,LRH）中系统保留盆腔自主神经（pelvic autonomic nerve,PAN）对膀胱功能恢复的影响。方法 2008年10月～2009年10月42例LRH（宫颈癌ⅠA2～ⅠB1 26例,子宫内膜癌ⅠB～ⅡA 16例）,系统保留PAN 10例（保留PAN组）,32例常规LRH（常规组）,比较2种术式术后膀胱功能的恢复情况。结果所有手术均镜下完成,保留PAN组成功保留单侧PAN 4例,保留双侧PAN 5例,失败1例。保留PAN组术后膀胱功能恢复正常时间（9.2±4.6）d,与常规组（15.2±2.3）d相比明显缩短（t=-5.440,P=0.000）。保留PAN组2例拔尿管后出现尿频、尿痛,常规组有9例。术后切除标本阴道残端、USL、CL长度均〉3 cm,切缘均未出现癌细胞的情况。结论腹腔镜下保留PAN的广泛性子宫切除术,可促进膀胱功能恢复,但远期临床效果还有待观察。

Laparoscopic Radical Hysterectomy with Preservation of the Pelvic Autonomic Nerve: Report of 10 Cases

Objective To investigate laparoscopic radical hysterectomy（LRH） with the pelvic autonomic nerve（PAN） being perserved on bladder function recovery. Methods From October 2008 to October 2009,42 patients with cervical cancer at stage ⅠA2-ⅠB1（26 cases） or endometrial carcinoma at stage ⅠB-ⅡA（16 cases） received LRH in our hospital.Of the cases,the PAN was preserved systematically in 10 patients（PAN group）,the other 32 cases who had routine LRH were set as a control（Routine group）.The postoperative bladder function of the two groups were compared. Results All the operations were completed under laparoscope.In the PAN group,the PAN was preserved unilaterally in 4 patients,bilaterally in 5,and failure in one.PAN group showed significantly shorter recovery time for bladder function than the Routine group [（9.2± 4.6） d vs.（15.2±2.3） d,t=-5.440,P=0.000）.There were 2 and 9 cases respectively in the PAN and Routine groups showed frequent urination and odynuria.The length of vaginal stump,USL,and CL were all less then 3 cm.No cancer cells were detected at the surgical resection margin. Conclusions Laparoscopic radical hysterectomy with the PAN preserved improves the recovery of the bladder function.Further studies are needed to observe long-term outcomes.