保留盆腔自主神经的根治性子宫切除术治疗宫颈癌的临床研究

Preliminary study on the clinical effect of nerve sparing radical hysterectomy for cervical cancer

目的探讨保留盆腔自主神经的根治性子宫切除术(NSRH)治疗宫颈癌的临床疗效及技术上的可行性。方法选择我院2008年4月至2009年10月FIGO分期为ⅠB～ⅡB的子宫颈癌患者69例,研究组(n=33)采用NSRH,对照组(n=36)为传统的Piver-RutledgeⅢ型宫颈癌根治术RH,比较两组术后膀胱和直肠功能的恢复情况以及手术时间、术中出血量和手术切除范围。结果研究组与对照组相比,术后残余尿<100ml的平均时间分别为(12.64±4.49)d和(17.89±4.19)d,术后残余尿<50ml的平均时间分别为(14.30±5.87)d和(19.69±4.48)d,术后肛门排气时间分别为(62.99±11.99)h和(79.32±13.22)h,术后排便时间分别为(95.42±12.54)h和(120.04±21.00)h,组间比较差异有统计学意义(P<0.001)。部分患者术后尿流动力学的测定结果显示,在膀胱灌注阶段和排尿阶段两组结果均有差异(P<0.05)。研究组与对照组总手术时间中位数分别为252min(180～330min)和205min(150～270min),子宫切除时间中位数为89min(65～105min)和70min(55～90min),差异有统计学意义(P<0.05)。主、骶韧带和阴道切除的长度及术中出血量两组无显著性差异。结论保留盆腔自主神经的根治性子宫切除术具有可行性和安全性,有利于术后膀胱、直肠功能的恢复。

Objective To discuss the feasibility and effect of never sparing radical hysterectomy（NSRH）for cervical cancer.Methods From April 2008 to October 2009,sixty-nine patients with FIGO stage ⅠB-ⅡB cervical cancer were selected to receive NSRH（study group,33 cases）or Piver-Rutledge Ⅲ radical hysterectomy（RH）（control group,36 cases）.The urethra /bladder and anal/rectum function after the operation,duration of surgery,blood loss and the excision extent were compared between the two groups.Results The time to achieve a postvoid residual urine volume（PVR）less than 100 ml of study group and control group were（12.64±4.49）d and（17.89±4.19）d,the time to achieve PVR less than 50 ml were（14.30±5.87）d and（19.69±4.48）d,the first exhaust time were（62.99±11.99）h and（79.32±13.22）h,and the first stool time were（95.42±12.54）h and（120.04±21.00）h,showing statictic significance between the two groups（P0.001）.Urodynamic study on postoperative bladder function in partial patients showed that there were significant differences between two groups in storage phase and voiding phase of bladder.The median whole operation time were 252min（180-330min）and 205min（150-270min）（P0.05）,the median operation time of uterus removal were 89min（65-105 min）and 70min（55-90min）,showing statistic significance between the two groups（P0.05）,and there was no difference between two groups in excision extent and blood loss during operation.Conclusion NSRH for the patients with FIGO stageⅠB-ⅡB cervical cancer is safe and feasible,and can improve the recovery of postoperative bladder and rectum function.