保留一侧或两侧盆腔神经的广泛性子宫切除术治疗宫颈癌的可行性及其术后膀胱和肠功能恢复的评价

Feasibility of unilateral or bilateral nerve-sparing radical hysterectomy in patients with cervical cancer and evaluation of the post-surgery recovery of the bladder and rectal function

目的 初步探讨保留一侧或两侧盆腔神经的广泛性子宫切除术的可行性和对术后膀胱直肠功能恢复的评估.方法 选择2008年8月至2009年10月浙江省肿瘤医院妇瘤科收治的61例Ⅰb1～Ⅱa期子宫颈癌患者,其中28例行保留盆腔神经的子宫广泛性切除术（NSRH）,33例行传统的子宫广泛性切除术（RH）.NSRH组中,有10例患者行保留一侧盆腔神经手术（UNSRH）,18例患者行保留两侧盆腔神经手术（BNSRH）.分别监测NSRH和RH的手术时间、手术出血量及术后并发症,观察手术对膀胱和直肠功能恢复的影响.结果 NSRH组的手术时间、手术出血量、术后住院时间和残余尿量分别为（224.5±40.0）min、（464.3±144.0）ml、（8.4±2.0）d和（64.8±16.9）ml,RH组分别为（176.4±30.0）min、（374.2±138.7）ml、（9.2±1.8）d和（70.6±16.0）ml,差异均无统计学意义（均P〉0.05）.UNSRH组的手术时间、手术出血量、术后住院时间和残余尿量分别为（208.5±28.5）min、（440.0±104.9）ml、（9.1±1.8）d、（68.3±12.5）ml,BNSRH组分别为（233.3±43.1）min、（477.8±162.9）ml、（8.7±2.1）d和（62.8±20.0）ml,两组差异均无统计学意义（均P〉0.05）.NSRH组术后留置膀胱造痿管时间为（12.4±5.2）d,RH组为（22.4±9.7）d,差异有统计学意义（P〈0.05）.BNSRH组术后留置膀胱造瘘管时间为（9.1±2.0）d,UNSRH组为（18.2±3.6）d,差异有统计学意义（P〈0.05）.术后3周,NSRH组的排尿和排便满意度分别为100%和75.0%,RH组分别为54.5%和24.2%,差异均有统计学意义（均P〈0.05）.结论 保留一侧或两侧盆腔自主神经的广泛性子宫切除术对治疗早期宫颈癌是安全可行的,此手术方式能有效地改善术后膀胱功能及直肠功能恢复.

Objective To investigate the feasibility of unilateral or bilateral nerve-sparing radical hysterectomy and evaluate the recovery of bladder and bowel function postoperatively.Methods From August 2008 to October 2009, sixty-one patients with cervical cancer stage Ⅰ b1 to Ⅱ a underwent radical hysterectomy （ 33 cases） and nerve-sparing radical hysterectomy （ 28 cases）.Unilateral nerve-sparing radical hysterectomy was performed in 10 patients, and bilateral nerve-sparing radical hysterectomy （BNS） was performed in 18 patients.The data of operation time, blood loss, postoperative hospital stay days, residual urine volume, and postoperative complications were collected.The postoperative recovery of bladder and bowel function was evaluated.Results There were no significant differences between nerve-sparing radical hysterectomy （NSRH） and radical hysterectomy （ RH ） groups in operation time [NSRH：（ 224.5±40.0 ）min,RH：（176.4 ±30.0 min）], blood loss [NSRH：（464.3±144.0） mi,RH：（374.2±138.7） ml],postoperative hospital stay days [NSRH：（8.4 ± 2.0 ） d, RH：（9.2 ± 1.8 ） d, and residual urine volume [NSRH：（64.8 ± 16.9） mi, RH：（70.6 ± 16.0） ml].There were also no significant differences betweenUNSRH and BNSRH groups in operation time [UNSRH：（208.5±28.5 ） min, BNSRH：（233.3±43.1 ）min], blood loss [UNSRH：（440.0±104.9） ml, BNSRH：（ 477.8±62.90） ml], postoperative hospital stay days [UNSRH：9.1±1.8） d, BNSRH：（8.7±2.1d], and the residual urine volume [UNSRH：（68.3±12.5） ml, BNSRH：（62.8±20.0） ml].There was a significant difference in the time of the Foley catheter removal between NSRH [（ 12.4±5.2） d] and RH [（22.4 ± 9.7 ） d] groups.There was a significant difference in the time of the Foley catheter removal between UNSRH [（ 18.2±3.6） d] and BNSRH [（9.1±2.0）d] groups.During the postoperative 3 weeks follow-up, the patients in the NSRH group had a higher rate of satisfaction at urination and defecation （ 100%, 75% ） than the RH group （54.5%,24.2% ）.Conclusion UNSRH and BNSRH are safe and feasible techniques for early stage cervical cancer, and may significantly improve the recovery of bladder and rectal function.