子宫次广泛/广泛切除手术保留盆腔植物神经对膀胱功能恢复保护作用的初步观察  

Preliminary study of pelvic autonomic nerve-sparing sub-radical/radical hysterectomy on preserving postsurgical bladder function in patients with cervical and endometrioid cancer.

作　　者：臧荣余[1] 程玺[1] 汤洁[1] 杨慧娟[1] 

机构地区：[1]复旦大学附属肿瘤医院,上海200032

出　　处：《现代妇产科进展》2006年第10期773-775,I0002,共4页Progress in Obstetrics and Gynecology

基　　金：上海市"医苑新星"计划和"浦江人才计划"资助项目

摘　　要：目的：初步探讨子宫次广泛／广泛切除手术主韧带切除时保留腹下神经和盆腔内脏神经对术后膀胱功能保护作用技术上的可行性。方法：2006年7月3日至2006年8月11日，复旦大学附属肿瘤医院收治子宫颈癌和子宫内膜癌，切除主韧带保留腹下和盆腔内脏神经的病例12例。结果：子宫内膜癌子宫次广泛手术4例，术后3—4天拔除尿管，拔除后即刻自行排尿，无残余尿。6例Ib1～Ⅱa期子宫颈癌患者中5例术后7天拔除尿管；1例患者1周拔除尿管失败，情绪紧张，复置尿管时出尿400ml，1用后成功拔除。2例Ⅱ。期子宫颈癌患侧贴盆壁切除主韧带，健康侧保留神经者，分别于术后10天和14天成功拔除尿管。结论：保留盆腔植物神经的子宫主韧带切除手术在子宫次广泛切除手术中易于推广；在广泛性子官切除术中需要进一步探索；对于Ⅱb期子宫颈癌不主张保留神经。Objective：To investigate the effects of the technique for preserving the hypogastric nerves and pelvic splanchnic nerves on postsurgical bladder function. Methods：Between July 3,2006 and August l 1,2006, a nerve-sparing cardinal ligament resection was carried out on 12 consecutive patients with uterine cervical cancer and endometrioid cancertreated at Fudan University Cancer Hospital. Results： Catheter was routinely removed 3 -4 days after subradical hysterectomy in patients with endometrioid cancer,and 7 days after radical hysterectomy in 5 patients withcervical cancer. One patient with stage I bl cervical cancer was failed to remove the catheter at 7 days after surgery and removed at 14 days. The catheter was removed at 10 and 14 days after ultra-radical hysterectomy in 2patients with stage Ⅱb cervical cancer. Conclusions： Pelvic autonomic nerve-sparing cardinal ligament-resection may be strongly recommended in sub-radical hysterectomy,and those procedures should be improved in radical cardinal ligament resection, However, it is difficuhy to preserve pelvic autonomic nerve plexus in patients with stage Ⅱb cervical cancer.

关 键 词：腹下神经 盆腔内脏神经丛 子宫颈肿瘤 子宫内膜肿瘤 膀胱功能 

分 类 号：R714.2[医药卫生—妇产科学]