宫颈癌根治术中开放阴道断端的意义

A Study of Non-closure for Vaginal Cuff in Radical Hysterectomy for Cervical Cancer

[目的]探讨开放阴道断端在宫颈癌根治术中的意义。[方法]选取宫颈癌根治术患者138例,根据阴道断端的开放或闭合分为两组(A组,开放组65例;B组,闭合组73例)。比较两组术后康复情况及术后3个月阴道残端的长度。[结果]A、B两组平均术后发热时间为5.45d与5.95d(P=0.24);平均术后拔除腹腔引流管时间均为5.51d;发生阴道残端或(及)盆腔感染分别为4/65例(6.2%)与7/73例(9.6%)(P=0.46),以上三组数据均无统计学差异。但是A组淋巴囊肿发生率高于B组(29.2%vs.13.7%,P=0.025)。术后3个月门诊复查,A组患者的阴道平均长度6.82±0.61cm,而B组为5.11±0.39cm(P<0.01)。[结论]开放或闭合阴道断端对宫颈癌根治术后的近期康复影响无显著差异,但开放阴道断端可以明显增加阴道残端长度,改善术后性生活质量。开放阴道断端对年轻宫颈癌患者更有意义。

[Purpose] To investigate the significance of non-closure for vaginal cuff in radical hysterectomy. [Methodsl One hundred and thirty-eight cases with cervical cancer undergoing radical hysterectomy were enrolled. The cases were divided into two groups： group A, opened vaginal cuff, 65 cases; group B： closed vaginal cuff, 73 cases. The postoperative rehabilitation, and the length of vaginal cuff of two groups at three months after surgery were compared. [ Results ] The mean duration of fever after operation was 5.45 days in group A and 5.95 days in group B（P=0.24）. Mean time of abdominal drainage tube withdrawed was 5.51 days in both groups. Four cases（6.2%） in group A and 7（9.6%） in group B had infection of vaginal cuff or/and pelvis （P=0.46）. Complications including fever, and pelvic infection were similar in both groups. However, the incidence of lymphatic cyst was significantly higher in group A than that in group B （29.2% vs. 13.7%, P=0.025）. Follow-up after three months, the mean length of vaginal cuff measured was 6.82±0.61cm in group A, and 5.11±0.39cm in group B （P〈0.01）. [Conclusion ] Both opened or closed vaginal cuff for radical hysterectomy result a similar postoperative rehebilitation, but the non-closure of vaginal cuff technique lengthen vaginal stump, and improves quality of sexual life. Therefore, it is much valuable for young women with cervical cancer.