腹腔镜下C1型子宫切除术治疗宫颈癌的临床价值  

Clinical value of laparoscopic type C1 hysterectomy in treatment of cervical cancer

作　　者：吴学明[1] 陈燕娥[1] 陈绵[1] WU Xue-ming;CHEN Yan-e;CHEN Mian(Department of Gynecology,Haikou Hospital of the Maternal and Child Health,Haikou Hainan 570203,China)

机构地区：[1]海口市妇幼保健院妇科,海南海口570203

出　　处：《局解手术学杂志》2021年第9期787-791,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：海南省重点研发计划项目(ZDYF2019102)。

摘　　要：目的探讨腹腔镜下保留盆腔自主神经(PAN)的子宫切除术治疗宫颈癌的临床应用效果。方法纳入我院收治的106例宫颈癌患者进行前瞻性研究,采用随机数字表法将患者分为对照组和观察组,每组53例。观察组患者行腹腔镜下C1型子宫切除术(保留PAN),对照组行腹腔镜下C2型子宫切除术(不保留PAN)。记录并比较2组患者围术期相关指标、术后性功能、膀胱功能及生存情况。结果2组患者术中出血量及淋巴结切除数目比较,差异无统计学意义(P>0.05);观察组患者手术时间长于对照组(P<0.05),但尿管留置时间、术后排气时间、术后排便时间及术后住院时间短于对照组(P<0.05)。观察组患者术后3个月女性性功能指数(FSFI)各项评分均高于对照组(P<0.05),术后膀胱功能障碍总发生率较对照组低(P<0.05)。随访期间,Kaplan-Meier分析显示,2组患者累积总生存率、累积无病生存率比较,差异无统计学意义(Log-rankχ2=0.062、0.306,P=0.803、0.580)。结论腹腔镜下C1型子宫切除术不仅可以促进宫颈癌患者术后康复,而且对患者直肠、膀胱及性功能具有较好的保护作用。Objective To investigate the clinical effect of pelvic autonomic nerve-sparing laparoscopic hysterectomy in the treatment of cervical cancer.Methods A total of 106 patients with cervical cancer admitted to our hospital were prospectively selected,and the patients were divided into the control group and the observation group by random number table method,with 53 cases in each group.Laparoscopic type C1 hysterectomy(PAN sparing)was performed in the observation group,and laparoscopic type C2 hysterectomy(without PAN sparing)was performed in the control group.Perioperative related indexes,postoperative sexual function,bladder function and survival of patients in the two groups were recorded and compared.Results There was no significant difference in intraoperative blood loss or the number of lymph node resection between the two groups(P>0.05),the operation time of the observation group was longer than that of the control group(P<0.05),while the catheter indwelling time,postoperative exhaust time,postoperative defecation time and postoperative hospital stay of the observation group were shorter than those of the control group(P<0.05).The female sexual function index(FSFI)scores of each item in the observation group were significantly higher than those in the control group 3 months after operation(P<0.05),the total incidence of postoperative bladder dysfunction in the observation group was lower than that in the control group(P<0.05).During the follow-up period,the Kaplan-Meier analysis showed that there was no significant difference in the cumulative overall survival rate or cumulative disease-free survival rate between the two groups(Log-rankχ2=0.062,0.306,P=0.803,0.580).Conclusion Laparoscopic type C1 hysterectomy can not only promote the postoperative recovery of patients with cervical cancer,but also have a better protective effect on rectal,bladder and sexual function.

关 键 词：腹腔镜 保留盆腔自主神经 C1型子宫切除术 宫颈癌 下腹下神经丛 盆腔内脏神经 腹下神经 

分 类 号：R737.33[医药卫生—肿瘤]