腹腔镜下完成宫颈癌保留神经平面广泛子宫切除术的疗效及可行性探讨  

Feasibility and Effect of Laparoscopy in the Modified Nerve Plane-sparing Radical Hysterectomy of Cervical Cancer

作　　者：王卉[1] 梁培琴[1] 

机构地区：[1]南方医科大学第三附属医院妇产科,广东广州510610

出　　处：《河北医学》2015年第3期398-401,共4页Hebei Medicine

基　　金：广东省科技计划项目;(编号:20110268)

摘　　要：目的：探讨腹腔镜下完成宫颈癌保留神经平面广泛子宫切除术（ NPSRH）的疗效及可行性。方法：选择2009年1月至2014年3月收治的94例宫颈癌患者（ Ib1期～Ⅱa2期），其中接受开腹NPSRH50例患者作为对照组，术中未应用特殊器械；接受腹腔镜NPSRH44例作为观察组，术中利用盆腔的固有间隙，将输尿管下方自主神经平面做整体保留，术中同时应用血管钉对神经平面周围的血管进行止血。比较两组患者的各手术相关指标及术后近期膀胱功能的恢复情况。结果：观察组的手术时间为（314．9±68．6）min要多于对照组的（273．5±58．6）min，两组比较差异有统计学意义（P＜0．05）；失血量为（187．8±64．1）mL、输血者比例为6．8％（3／44）、术后住院时间分别为（9．1±2．0）d均明显低于对照组（474．6±67．3）mL、48％（24／50）、（11．3±3．1） d，差异均具有统计学意义（均P＜0．05）。在拔尿管后，两组患者初次残余尿达标者的比例及导尿时间比较，差异均无统计学意义（均P＞0．05）。结论：腹腔镜下完成NPSRH的疗效及保留神经的效果与开腹手术相当，但能明显减少患者术中的出血情况，且能促进患者的术后恢复。Objective：To assess the feasibility and safety of laparoscopic nerve plane -sparing radical hysterectomy（NPSRH） of cervical cancer and compare with that of open NPSRH .Method：Ninety-four pa-tients with FIGO stage I b 1-Ⅱa2 cervical cancer were enrolled in the study .Forty-four patients underwent laparoscopic NPSRH.During the operation,the pelvic autonomic nerve plane which is directly underneath the ureter was integrally preserved by dissecting the pelvic spaces laparoscopically .The vessels around the nerve plane were controlled by Hem-o-lok polymer clips.Fifty patients underwent open NPSRH without special in-struments .The clinical ,pathological and surgery-related parameters were compared between the two groups . Moreover ,postoperative short-term bladder function of the patients was analyzed .Result：The mean duration of surgery in the laparoscopic group was significantly longer [（314.9±68.6）min vs.（ 273.5±58.6）min] （P〈0.05）.But the laparoscopic group had less blood loss [（187.8±64.1）mL vs.（474.6±67.3）mL,P〈0.05] and blood transfusion rate [6.8%（3/44）vs.49.5%（24/50）,P〈0.05].There was no significant difference re-garding the proportion of patients who firstly passed the post-void residual urine volume（PVR）test（P〉0. 05）.The median time of catheterization between the two groups were also comparable （P〉0.05）.However,the postoperative hospital stay was significantly shorter in the laparoscopic group [ median postoperative hospital stay（9.1±2.0）days vs.（11.3±3.1）days,P〈0.05].Conclusion：Laparoscopic NPSRH is feasible .It seems to be comparable with open NPSRH in terms of preserving pelvic nerve function ,but is more favorable in terms of blood loss and postoperative recovery .

关 键 词：腹腔镜手术 宫颈癌 子宫切除术 自主神经 

分 类 号：R737.33[医药卫生—肿瘤]