腹腔镜下保留盆腔自主神经广泛性子宫切除术在Ⅰa、Ⅰb1期宫颈癌患者中的应用  

Application of laparoscopic nerve-sparing radical hysterectomy in patients with stage Ⅰ a and Ⅰ b1 cervical cancer

作　　者：张荣荣[1] 昝培霞 林萍[1] ZHANG Rong-rong;ZAN Pei-xia;LIN Ping(Department of Gynecology,Xuzhou Maternal&Child Health Hospital,Xuzhou 221000)

机构地区：[1]徐州市妇幼保健院妇科,徐州221000

出　　处：《生殖医学杂志》2024年第8期1045-1050,共6页Journal of Reproductive Medicine

基　　金：江苏省妇幼健康科研项目(F202167)。

摘　　要：目的探究Ⅰa、Ⅰb1期宫颈癌患者行腹腔镜下保留盆腔自主神经广泛性子宫切除术(LNSRH)对其尿流动力学、性功能及并发症发生情况的影响。方法选取2019年5月至2022年5月在徐州市妇幼保健院接受治疗的早期宫颈癌患者80例为研究对象,采用随机数字表法分成对照组(n=40)和观察组(n=40)。对照组行腹腔镜下广泛性子宫切除术(LRH),观察组行LNSRH。比较两组患者的基本资料、围术期指标、肿瘤标志物水平、尿流动力学指标、性功能评分及并发症发生情况。结果两组患者的临床分期、年龄、体质量指数、病理类型比较均无显著性差异(P>0.05)。观察组手术时间显著长于对照组[(246.85±30.79)min vs.(227.41±28.43)min,P<0.05];两组出血量、清扫淋巴结数量、切除阴道长度、住院时间比较均无显著性差异(P>0.05)。两组患者术后的糖类抗原125(CA-125)、鳞状上皮细胞癌抗原(SCCA)水平均显著低于术前(P<0.05);两组间术后CA-125、SCCA水平比较无显著性差异(P>0.05)。两组患者术后最大尿流率(MFR)、最大逼尿肌收缩压(MDP)、膀胱顺应性水平均显著低于术前(P<0.05);观察组术后MFR、MDP及膀胱顺应性水平显著高于对照组(P<0.05)。两组患者术后女性性功能量表(FSFI)各维度评分均显著低于术前(P<0.05);观察组术后FSFI各维度评分显著高于对照组(P<0.05)。观察组术后并发症发生率显著低于对照组(12.50%vs.32.50%,P<0.05)。结论对Ⅰa、Ⅰb1期宫颈癌患者予以LNSRH和LRH治疗均有较好的疗效,可有效降低肿瘤标志物水平,且LNSRH对患者尿流动力学和性功能影响较小,术后并发症较少。Objective:To explore the effects of laparoscopic nerve-sparing radical hysterectomy(LNSRH)on urinary fluidity,sexual function and complications in patients with stageⅠa andⅠb1 cervical cancer.Methods:A total of 80 patients with early-stage cervical cancer admitted to Xuzhou Maternal&Child Health Hospital Department of Gynecology from May 2019 to May 2022 were prospectively selected and included in the study.They were divided into the control group and the observation group by random number table method,with 40 cases in each group.The control group received laparoscopic radical hysterectomy(LRH),and the observation group underwent LNSRH.The basic characteristics,perioperative indicators,tumor marker levels,urodynamics indicators,sexual function scores and postoperative complications were compared between the two groups.Results:There were no significant differences in clinical stage,age,body mass index and pathological type between the two groups(P>0.05).The operation time of observation group was significantly longer than that of control group[(246.85±30.79)min vs.(227.41±28.43)min,P<0.05].There were no significant differences in the amount of blood loss,the number of lymph node dissection,the length of vaginal resection and the length of hospital stay between the two groups(P>0.05).The levels of carbohydrate antigen 125(CA-125)and squamous cell carcinoma antigen(SCCA)were significantly lower after operation compared with those before operation(P<0.05),but there was no significant difference between the two groups after operation(P>0.05).After operation,the maximum urine flow rate(MFR),maximum detrusor pressure(MDP)and bladder compliance levels in two groups were significantly lower than those before operation,but these indicators of the observation group were significantly higher than those in the control group(P<0.05).After operation,the scores of female sexual function scale(FSFI)for each dimension in both groups were significantly lower than those before operation,but these scores of the observation grou

关 键 词：早期宫颈癌 腹腔镜下广泛性子宫切除术 腹腔镜下保留盆腔自主神经广泛性子宫切除术 

分 类 号：R737.33[医药卫生—肿瘤]