保留盆腔植物神经的广泛性子宫切除术治疗子宫颈癌的初步研究  

A prospective study on nerve-sparing radical hysterectomy in patients with cervical cancer

作　　者：李斌[1] 张蓉[1] 吴令英[1] 张功逸[1] 李贤[1] 俞高志[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院妇瘤科,北京100021

出　　处：《中华妇产科杂志》2008年第8期606-610,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨保留盆腔植物神经的广泛性子宫切除术（NSRH）治疗宫颈癌的可行性，并评估其改善术后膀胱功能的效果。方法选择接受手术治疗的临床分期为Ⅰb1～Ⅱa期的宫颈癌患者44例，分为两组。研究组22例患者接受NSRH手术，术中在处理主韧带、宫骶韧带、深层的膀胱宫颈韧带及阴道旁组织时，保留盆腔内脏神经、腹下神经、下腹下神经丛及其膀胱支；对照组22例患者接受经典的广泛性子宫切除手术（即Piver Ⅲ类子宫切除术）。对比两组患者的术中及术后并发症发生情况。结果研究组术中出血量为（550±241）ml，对照组为（475±284）ml，两组比较，差异无统计学意义（P〉0．05）；研究组手术时间为（329±43）min，对照组为（272±56）min，两组比较，差异有统计学意义（P〈o．01）。术后第8天，研究组及对照组中残余尿量〈100ml的患者比例分别为68％及18％，两组比较，差异有统计学意义（P〈0．01）；研究组留置尿管时间（8～23d，中位时间8d）与对照组（8～32d，中位时间20d）比较，差异有统计学意义（P〈0．01）。两组患者均无严重的手术相关性损伤及病理切缘不净的情况发生。结论NSRH治疗早期子宫颈癌安全、可行，且能明显改善患者术后的膀胱功能。Objective To assess the nerve-sparing radical hysterectomy （NSRH） technique and its impact on postoperative voiding function. Methods Forty-four patients with International Federation of Gynecology and Obstetrics（FIGO） stage Ⅰ b1 - Ⅱ a cervical cancer were enrolled and randomized into NSRH group （ study group, n = 22 ） and conventional radical hysterectomy （CRH） group （ control group, n = 22 ）. The pelvic autonomic nerve pathway （including hypogastric nerve, pelvic splanchnic nerve, inferior hypogastric plexus and bladder branch） was completely preserved in the NSRH group. Related parameters were compared between the two groups. Results The estimated blood loss in NSRH group and CRH group were （550 ±241） ml and （475±284） ml, respectively, with no significant difference （P 〉0. 05）. The mean operation time in NSRH group and CRH group were （329 ± 43 ） min and （272 ± 56） min, respectively, with a significant .difference （P 〈 0. 01 ）. More patients in NSRH group had post-void residual urine volume （PVR） 〈 100 ml than that in CRH group on day 8 after surgery （68 % vs. 18%, P 〈0. 01 ）. The median duration of postoperative catheterization was significantly shorter in NRSH group （ 8 - 23 days, median 8 days） than that in CRH group （8 -32 days, median 20 days;P 〈0. 01 ）. Neither surgery-related injury nor pathologically positive margin was reported in either of the groups. Conclusions NSRH is a feasible and safe technique for preserving bladder function. Larger prospective studies are needed to confirm the efficacy of this technique.

关 键 词：宫颈肿瘤 子宫切除术 骨盆 自主神经通路 

分 类 号：R686[医药卫生—骨科学]