根治性子宫切除术中保留盆腔自主神经的初步研究  

Preliminary study of nerve sparing radical hysterectomy in patients with cervical cancer

作　　者：孙力[1] 吴令英[1] 章文华[1] 李晓光[1] 宋艳[2] 张询[2] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院妇瘤科,100021 [2]中国医学科学院北京协和医学院肿瘤医院病理科,100021

出　　处：《中华肿瘤杂志》2009年第8期607-611,共5页Chinese Journal of Oncology

摘　　要：目的探讨保留盆腔自主神经的根治性子宫切除术（NSRH）的技术要点及可行性，评价其改善子宫颈癌患者术后膀胱功能的作用。方法选择42例拟行根治性子宫切除加盆腔淋巴结清扫术的Ⅰb1～Ⅰb2期子宫颈鳞癌患者，研究组（21例）行NSRH，对照组（21例）行常规根治性子宫切除术，比较两组手术时间、失血量及术后留置尿管的时间。采用免疫组化SP法，检测两组患者手术切除的宫骶韧带和主韧带切缘中S-100蛋白的表达，比较两组神经含量的差异。结果研究组和对照组患者的手术时间分别为（248±24）min和（227±27）min，差异有统计学意义（P〈0．01）。研究组和对照组患者的术中失血量分别为（459±143）ml和（454±121）ml，差异无统计学意义（P〉0．05）。研究组和对照组患者术后尿管留置的中位时间分别为7d和16d，差异有统计学意义（P〈0．01）。术后7d，研究组和对照组残余尿量≤100ml的患者所占的比例分别为66．7％和19．0％，差异有统计学意义（P〈0．01）。两组患者均未发生严重的并发症，术后中位随访14个月（11～16个月），无一例患者出现复发转移。S-100免疫组化检测结果显示，常规根治性子宫切除的切缘中含有大量神经束，而NSRH切缘中仅含有较少的神经纤维，两组相比，差异有统计学意义（P〈0．01）。结论NSRH治疗早期子宫颈癌是可行和安全的，能减少手术过程中对盆腔自主神经的损伤程度，降低患者术后尿潴留的发生率。Objective To assess the feasibility of nerve sparing radical hysterectomy （NSRH） technique and the impact on the improvement of postoperative bladder function in patients with cervical cancer. Methods Forty-two patients with FIGO stage Ⅰb1～Ⅰb2 cervical cancer were selected to receive NSRH （study group, 21cases） or routine hysterectomy （RH） （control group, 21 cases）. Duration of surgery, blood loss and mean length of postoperative stay were compared between the two groups. Immunohistochemical analysis of surgical margins using a general nerve marker （S-100） was performed to compare the nerve damages. Results The operation time of NSRH group and RH group was （248 ±24） rain and （227 ±27） min, respectively, with a significant difference between the two groups （P 〈0.01 ）. No significant difference in blood loss was found between the NSRH and RH group [ （459 ± 143） ml vs. （454±121 ）ml ,P 〉 0.051. However, the median urinary catheterization time was 7 days in NSRH group versus 16 days in the RH group, with a statistically significant difference between the two groups （P 〈0.01 ）. The rate of patients who had postoperative residual urine volume in bladder （PVR） ≤100 ml was 66.7% in the NSRH group versus 19.0% in the RH group, with a significant difference between the two groups （P 〈 0.01 ）. No severe perioperative complications occurred in both groups. After a follow-op of 11 to 16 months （median： 14 months）, no recurrence was detected in the two groups. Immunohistochemistry with S-100 staining revealed only small nerve fibers in the surgical margins of the NSRH group, but full with large nerve bundles in that of the RH group. There was a significant difference between two group （ P 〈 0. 01 ）. Conclusion The results of our preliminary study indicate that nerve sparing radical hysterectomy （NSRH） for the patients with FIGO stage Ⅰb1～Ⅰb2 cervical cancer is safe and feasible, and can well preserve thepelvic autonomic nerves and impr

关 键 词：子宫颈癌 子宫切除术 盆腔自主神经 膀胱功能 

分 类 号：R686[医药卫生—骨科学]