腹腔镜下保留盆腔神经丛的根治性子宫切除术的临床观察

Clinical research of laparoscopic nerve-sparing radical hysterectomy

目的探讨腹腔镜下保留盆腔神经丛的根治性子宫切除术治疗子宫恶性肿瘤的可行性和临床效果，及其对膀胱功能的影响。方法2006年5月10日至2007年1月20日西南医院收治50例子宫恶性肿瘤患者，行腹腔镜下保留盆腔神经丛的根治性子宫切除术的患者25例作为研究组（LNSRH组），行腹腔镜下根治性子宫切除术的患者25例作为对照组（LRH组），进行前瞻性对照分析。结果（1）入组病例50例均顺利完成手术，LNSRH组在手术时间、术后肠道恢复时间、切除盆腔淋巴结的数目、宫旁和阴道切除的范围和LRH组比较差异无统计学意义，术中出血量、术后住院时间明显少于LRH组。LNSRH组术中输尿管损伤1例，镜下修补成功；LRH组术后深静脉血栓和淋巴囊肿各1例。（2）LNSRH组术后拔除尿管平均时问为（10．6±2．74）d（7～17d），LRH组为（17．24±4．24）d（9～25d）。随访11～19个月，所有患者健在，无复发和转移的病例。结论LNSRH组在技术上安全、可行，可明显减少术后膀胱功能障碍，既能保证疗效，又有利于患者术后的恢复及保证生活质量。

Objective To investigate the feasibility,clinical effects and the impact on bladder function of this laparoseopic nervesparing radical hysterectomy for the treatment of malignant uterine tumors. Methods Between May 10,2006 and Jan. 20,2007,50 consecutive patients with malignant uterine tumors were divided into LNSRH group and LRH group in Southwest Hospital. Their clinical data and follow up results were reviewed. Results （1）Of all the 50 patients were performed successfully. No significant differences were observed in terms of mean operation time,the recovery time of bowel,numbers of pelvic lymph nodes resected,extent of parametrium and vagina resection between the two groups. The quantity of mean intraoperative blood loss,and duration of postoperative hospital stay were better in the LNSRH group. In the LNSRH group,operative ureteral injury occurred in 1 patient was repaired laparoscopically. There were 2 cases of postoperative complications in the LRH group,one patient lymphocyst, and one patient deep venous thrombosis. （2）The mean time of catheter removed were （10. 6±2. 74）d（7- 17d）and （17.24±4.24）d（9- 25d）respectively. All patients were followed up for 11--19 months and no patient died. There were no local recurrence and no matastatic in the two groups. Conclusion Our data demonstrated that LNSRH is a safe and feasible technique which can reduce postoperative bladder dysfunction obviously. The nerve-sparing surgery can not only ensure the curative effect, but also benefit patient＇s recovery and life quality.