子宫颈癌Ⅲ类扩大子宫切除术手术技巧的改进与效果  

Improvements of the Surgical Techniques and Treatment Effects of Class Ⅲ Extended Hysterectomy in Invasive Cervical Cancer

作　　者：张帆[1] 陈惠祯[1] 蔡红兵[1] 聂道梅 

机构地区：[1]武汉大学中南医院妇瘤科,湖北武汉430071 [2]湖北省五峰土家族自治县妇幼保健院,湖北五峰443400

出　　处：《武汉大学学报（医学版）》2010年第1期114-117,共4页Medical Journal of Wuhan University

摘　　要：目的:为提高子宫颈癌的手术治疗效果,缩短手术时间,减少并发症的发生率,对宫颈癌Ⅲ类扩大子宫切除术的手术技巧进行改进,并对治疗效果进行评价。方法:1999年6月至2004年5月,196例宫颈癌ⅠB期及ⅡA期患者,按改进的Ⅲ类扩大子宫切除术进行手术,称为实验组。1994年6月至1999年5月,176例宫颈癌ⅠB期及ⅡA期患者,按常规的Ⅲ类扩大子宫切除术进行手术,称为对照组。对手术时间、出血量、人均输血量及泌尿道并发症进行了对比研究。结果:实验组与对照组比较,手术时间缩短,出血量和人均输血量减少(P均<0.01);术后膀胱功能障碍发生率分别为22.96%及51.13%,差异有显著性(P<0.01);泌尿道感染率分别为8.16%及16.78%,差异有显著性(P<0.05)。两组5年生存率无显著性差异(P>0.05)。结论:宫颈癌Ⅲ类扩大子宫切除术手术技术技巧的改进是有效的,有临床推广应用价值。Objective： To improve the surgical techniques of the class Ⅲextended hysterectomy in invasire cervical cancer and to evaluate the treatment effects. Methods： The clinical data of 196 cases of cervical carcinoma at stages I B and 11 A undergoing modified class Ⅲ extended radical hysterectomy between June, 1999 and May, 2004 were reviewed, and compared with those of another similar 176 cases with conventional surgical treatment between June, 1994 and May, 1999. Results：The class Ⅲ extended radical hysterectomy was modified as follows： the uterosacral ligaments were removed with electrotome; the tunnels of the ureters were separated and penetrated; the anterior lobe of the cervicovesical ligament was removed but the posterior lobe of the cervi- covesical ligament was remained; after ureters were drawn to the lateral side with an ＂S＂ hook and the urocyst lateral recessus were expanded, the cardinal ligaments were exposed and the ligaments near the pelvic wall were removed, but the inferior parts of these ligaments should be spared; when the paracolpium was excised, the posterior lobe of the cervicovesical ligaments were excised at the same time; 2 3 cm-long tissue of vagina was removed. As compared with the con ventional group, the modified group had a shorter surgical duration, less hemorrhage during op eration, less blood transfusion, and less urinary tract complications. Conclusion： The modified class Ⅲ procedures are effective and applicable in the treatment of invasive cervical cancer.

关 键 词：子宫颈肿瘤 子宫切除术 手术技巧 

分 类 号：R713.42[医药卫生—妇产科学]