根治性子宫切除术中系统保留盆腔自主神经的临床研究

Clinical study on sparing the pelvic autonomic nerve during the radical hysterectomy

目的观察根治性子宫切除术中系统保留盆腔自主神经(PAN)的临床效果。方法对2007年6月至2008年4月南方医科大学南方医院等5家医院收治的40例子宫颈癌及子宫内膜癌患者实施根治性子宫切除术中保留PAN的手术,观察手术的成功率,手术前后膀胱功能、肛门和(或)直肠功能变化。结果(1)33例成功保留双侧PAN,成功率82.5%(A组);7例失败,占17.5%(B组),失败的原因为肥胖、术中出血多及盆腔粘连等。(2)A、B两组的手术切除范围无差异,均达Ⅲ型子宫切除术标准。(3)手术平均时间:A组:(200.3±64.8)min,B组:(190.4±50.9)min,P>0.05;术中出血量:A组:(714.6±387.6)mL,B组:(614.3±11.6)mL,P>0.05;平均留置尿管时间:A组:(8.6±2.0)d,B组:(17.7±4.9)d,P<0.01;术后排气时间:A组:(58.5±20.3)h,B组:(81.3±6.2)h,P<0.05;术后排便时间:A组:(90.6±29.0)h,B组:(115.4±46.4)h,P<0.05。结论根治性子宫切除术中系统保留PAN有助于尽快恢复膀胱功能以及肛门和(或)直肠功能。

Objective To evaluate the clinical effect of sparing the pelvic autonomic nerve （PAN）during the radical hysterectomy. Methods Between June 2007 and April 2008, forty patients underwent nerve sparing radical hysterectomy, and their success rates of surgery, their lower urethra/bladder and anal/rectum function before and after the operation were observed. Results Of the 40 patients 33 patients were successfully spared the bilateral PAN, the rate being 82. 5% （ group A） ; however, the remaining 7 patients failed to preserve the nerve, the rate being 17. 5% （ group B）. Reasons for not preserving the nerves were obesity, much more blood loss during the operation, pelvic adhesion and so on. （2）There is no difference between group A and group B in the excision extent, beth of which reached to the standard of III hysterectomy. （3） The mean operation time of group A and group B were （200. 3±64. 8）min and （ 190. 4±50.9）min respec- tively, with no significant difference（ P 〉 0. 05 ） ; the estimated blood loss during operation of group A and group B were （714. 6 ±387.6） mL and （614. 3 ± 11.6） mL,with no significant difference （P 〉0. 05）. The media duration of postoperative catheterization was significantly shorter in group A （8. 6 ± 2. 0days ） than that in group B （ 17.7 ± 4. 9 days, P 〈 0.01 ）. The first exhaust time of group A and group B was （58. 5±20. 3） hours and （81.3±6. 2） hours,with a significant difference （ P 〈 0. 05 ） ; the first stool time of group A and group B was （ 90. 6± 29.0 ） hours and （ 115.4 ±46. 4 ） hours, with a significant difference （ P 〈 0.05 ）. Conclusion During radical hysterectomy, sparing the PAN can benefit the lower urethra/bladder and anal/rectum function.