改良Piver Ⅲ型子宫切除术的临床报告

Clinical report of the modified Piver class m hysterectomy on invasive cervical cancer

目的 探索宫颈癌Piver Ⅲ型子宫切除术的手术范围,改进其手术技巧,以降低术后泌尿道并发症,缩短手术时间,减少手术出血量、输血量.方法 2000年6月至2005年5月,196例Ⅰ b期及Ⅱ a期宫颈癌患者,按改良的Piver Ⅲ型子宫切除术进行手术,为研究组;1994年6月至1999年5月,176例Ⅰ b期及Ⅱ a期宫颈癌患者,按常规的Piver Ⅲ型子宫切除术进行手术,为对照组.手术范围及手术技巧的改良主要包括用电刀协助分离阴道膀胱间隙;用电刀切断宫骶韧带的1/2;分离、贯穿输尿管隧道,断扎宫颈膀胱韧带前叶,同时断扎子宫动脉,保留子宫动脉输尿管支;用S状拉钩将输尿管拉向外侧,扩张膀胱侧窝,暴露主韧带,切除主韧带的3/4,保留该韧带后部部分组织;断扎阴道旁组织2 cm;切断阴道2～3 cm.结果 研究组患者术后膀胱功能障碍发生率为23.0%（45/196）,对照组为51.1%（90/176）,两组比较,差异有统计学意义（P〈0.01）;研究组泌尿道感染率为8.2%（16/196）,显著低于对照组[16.5%（29/176）],两组比较,差异有统计学意义（P=0.014）.研究组的手术时间、术中出血量和人均输血量分别为（132±20）min、（322±100）ml、（154±79）ml,均较对照组减少,分别比较,差异均有统计学意义（P〈0.05）.研究组与对照组患者的5年生存率分别为87.8%（172/196）及88.6%（156/176）,两组比较,差异无统计学意义（P=0.793）.结论 改良的Piver Ⅲ型子宫切除术手术范围及手术技巧的改进是有效的、可行的.

Objective To explore the surgical extent and to improve the surgical techniques of the Piver class Ⅲ hysterectomy on invasivc cervical cancer,so as to reduce the urinary tract complications,shorten the surgical duration,decrease the hemorrhage and blood transfusion.Methods The study group,196 cases with stages Ⅰ b and Ⅱ a carcinoma of the cervix underwent the modified Piver class Ⅲ hysterectomy from June 2000 to May 2005.The control group,176 cases of the same stages underwent the Pivet class Ⅲ hysterectomy between June 1994 and May 1999.The modified Piver class Ⅲ hysterectomy mainly include the surgical extent and some surgical techniques as follows.The cervicovesical and vesicovaginal space are separated with assistance of electrotome.Half of the uterosacral ligaments are removed with electrotome.The tunnel of the ureters is separated and penetrated or not. The anterior leaf of the cervicovesical ligaments is removed and the uterine artery are removed at the same time.while the ureter branch from the uterine artery are preserved.When the ureters aIe drawn to the lateral side of the body with an ＂S＂ hook and the urocyst lateral recessus are expanded.the cardinal ligaments can be exposed and be removed of 3/4.But part of the inferior of these ligaments should be preserved.The paracolpium are resected about 2 cm.2-3 cm tissue of the vagina is removed.Results Compare with the control group,the urinary tract complications of the study group were significantly reduced（51.1%versus 23.0%,P〈0.01）.There were a shorter surgical duration[（132±20）min],less of the hemorrhage[（322±100） ml]and blood transfusion[（154±79）ml] in the study group than those in the control group（all P〈0.05）.While,there was no significant difference at the survival rates of 5 years between the two groups （87.8% versus 88.6%.P=0.793）.Conclusion The modified Piver class Ⅲ hysterectomy is effective and applicable for patients with cervical cancer.