保留神经的根治性子宫切除术

Nerve-sparing Radical Hysterectomy

传统的根治性子宫切除术术后常引起一系列并发症,如膀胱功能障碍、肛门直肠功能紊乱和阴道功能障碍等。随着肿瘤外科的发展,在根治性子宫切除术中通过保留盆腔自主神经可显著减少术后并发症,改善患者术后生活质量。由于缺乏传统的根治性子宫切除术与保留盆腔神经根治性子宫切除术的疗效和并发症的临床随机对照研究,所以尚不能广泛推广。近年开展的大量手术实践有相关技术创新和随访数据。现就近年保留神经的根治性子宫切除术的适应证、手术步骤、手术技巧和并发症的进展进行综述,并阐述需要研究的问题。

Classic radical hysterectomy could frequently cause bladder dysfunction,anorectal mobility disorders and sexual dissatisfaction.Following improvement of surgical oncology,the autonomic pelvic nerves have been preseved during the phase of radical hysterectom,which has the lowed long-term postoperative complications and the improved quality of life.Although many operations and practice have been carried out during the last two decades,studies comparing the effectiveness and complications of classic radical hysterectomy with nerve-sparing radical hysterectomy,designed with the randomized case control,were scanty,which affected its widespread use in clinic.With the published follow-up data and technique innovation,we reviewed the selection criteria,operating procedures,technical details and complications of the nerve-sparing radical hysterectomy in early-stage cervical cancer,and raised some expectations for future research and practice.