腹腔镜下宫颈癌根治术保留盆腔自主神经的近期疗效观察

Short-term Efficacy of Laparoscopic Autonomic Nerve-Sparing Radical Hysterectomy

目的探讨腹腔镜下保留盆腔自主神经的根治性子宫切除术(laparoscopic nerve-sparing radical hysterec-tomy,LNSRH)治疗早期宫颈癌的近期临床疗效。方法对58例腹腔镜下宫颈癌根治术进行了前瞻性非随机的对照研究,其中LNSRH组26例,腹腔镜下根治性子宫切除术(laparoscopic radical hysterectomy,LRH)32例(LRH组),比较两组手术时间、术中出血量、清扫淋巴结数、阴道及宫旁切除长度、术后膀胱及直肠功能恢复情况等。结果两组均顺利完成手术。两组术中出血量、淋巴结清扫数、阴道及宫旁切除长度无明显差异(P>0.05)。LNSRH组手术时间[(145±17.6)min]显著长于LRH组[(120.3±19.8)min,P<0.05]。尿潴留LNSRH组1例,LRH组10例。两组尿潴留发生率有统计学差异(P<0.05)。58例患者随访2～16个月均存活,无复发。结论 LNSRH治疗早期宫颈癌安全可行,有利于术后膀胱、直肠功能的恢复,值得临床推广应用。

Objective To investigate the short-term efficacy and feasibility of laparoscopic autonomic nerve-sparing radical hysterectomy（LNSRH） in the treatment of early cervical cancer. Methods Between October 2009 and October 2010,we carried out prospective non-randomized control study on 58 postoperative patients with cervical cancer in our hospital, the patients were divided into LNSRH group （26 cases） and laparoscopic radical hysterectomy （LRH） group （32 cases）. Operation time,intraoperative blood loss, number of dissected lymph nodes,length of resected vagina and paracervical tissues, recovery of bladder function and recovery of rectum function after the surgery were compared between the two groups. Results The operations were completed successfully in all the 58 patients. No significant difference was detected between the two groups in terms of intraoperative blood loss, number of dissected lymph node, length of resected vagina and paracervieal tissues（P2〉0.05）. Whereas,LNSRH group had significantly longer operation timeE（145 ± 17.6） min VS（120.3±19.8）min, P〈0. 051. After the operation, 1 patients from the LNSRH group,and 10 patients from the LRH group developed urine retention （P〈0.05）. Follow-up was achieved in 58 patients for 2 to 16 months, all of them survived and nobody relapsed. Conclusion LNSRH is safe and feasible in the treatment of early cervical cancer which can be conducive to bladder and rectum function recovery.