子宫颈癌保留神经广泛性子宫切除术与传统广泛性子宫切除术的比较性研究

Nerve-sparing radical hysterectomy and radical hysterectomy： a retrospective study

目的回顾性比较保留神经的广泛性子宫切除术（NSRH）和传统的广泛性子宫切除术（RH）对宫颈癌患者盆腔自主神经功能的影响以及围手术期并发症的发生情况。方法选择2005年3月至2006年3月间在复旦大学附属肿瘤医院接受手术治疗的患者共93例，其中接受NSRH患者24例，为Ⅰb1-Ⅱa期宫颈浸润癌；接受RH患者69例，为Ⅰa～Ⅱb期宫颈浸润癌。观察上述两种手术对患者膀胱功能、直肠功能和性功能的影响，比较手术时间、术后住院时间、术中出血量和围手术期并发症的发生情况。结果术后平均尿管留置时间、肠蠕动恢复时间，NSRH和RH患者分别为8．7和14．8d、2．9和3．2d，NSRH患者均优于RH患者，分别比较，差异均有统计学意义（P〈0．01）。平均手术时间、术中出血量、术后住院时间，NSRH和RH患者分别为146．7和143．3min、441．7和565．9ml、10．21和10．19d，两者问分别比较，差异均无统计学意义（P〉0．05）。NSRH和RH患者术后病理检查均未提示有阳性手术切缘。NSRH患者未见围手术期并发症，而RH患者术后肠梗阻1例、淋巴囊肿感染1例。术后6个月随访时，NSRH患者的性生活满意度（29％，7／24）明显好于RH患者（9％，6／69），两者比较，差异有统计学意义（P=0．042）；NSRH患者排便正常，RH患者中有2例患者出现大便次数增多。结论NSRH手术能有效保护早期宫颈浸润癌患者的盆腔自主神经功能，目．安全可行。

Objective To compare Piver radical hysterectomy （RH） with nerve-sparing radical hysterectomy （NSRH） for cervical cancer patients in terms of postoperative physiology of pelvic autonomic nerve and perioperative complications. Methods Ninety-three consecutive patients with invasive cervical cancer underwent RH （69 cases） or NSRH （24 cases） from March 2005 to March 2006 at Fudan University Cancer Hospital. The postoperative function of bladder, bowel and sexual function and perioperative morbidity were assessed. Results Compared with patients received RH, patients underwent NSRH presented a significantly prompter recovery of bladder function （8. 7 vs. 14. 8 days, P 〈 0. 01 ） and bowel function （2. 9 vs. 3.2 days, P 〈 0. 01 ）. However, there were not significant difference in terms of operative time （ 146. 7 vs. 143.3 minutes, P 〉 0. 05）, estimated blood loss （441.7 vs. 565.9 ml, P 〉 0. 05 ） and hospital stay （ 10. 21 vs. 10. 19 days, P 〉 0. 05）. No positive surgical margin was found in both groups. No surgery complication was found in NSRH group, while there were 1 case presented the infection of lymphocyst and 1 case presented intestinal obstruction in RH group. After following up postoperative 6 months, the patients received NSRH had a higher rate of satisfaction at sex activity than those received RH （29% vs. 9%, P = 0. 042）. Conclusion NSRH is safe and feasible surgical management for cervical cancer patients, which would improved the physiology of pelvic autonomic nerve postoperatively.