保留神经的宫颈癌根治术的研究进展

Research progress in nerve-sparing radical hysterectomy for cervical cancer

早期宫颈癌患者首选手术治疗,传统宫颈癌根治术包括广泛性子宫切除术及盆腔淋巴结清扫术,该术式不可避免地造成盆腔自主神经损伤,导致盆底器官功能障碍。保留神经功能的宫颈癌根治术成为早期宫颈癌手术治疗的发展趋势。随着保留神经功能手术的安全性和可行性不断得到验证,该术式逐渐被接受。近年来,保留神经的术式经历了不断的演变和发展,与保留神经相关的手术解剖学也有相应的进展。单孔腹腔镜、机器人、迷你腹腔镜等手术操作系统也被应用于保留神经的根治术中。由于盆腔自主神经呈网状分布肉眼识别困难,术中不能确切保留神经,从而制约了手术的规范化及推广。术中神经电生理技术的应用可能成为保留神经手术的一个新的发展方向。

Early stage cervical cancer is mainly treated by radical hysterectomy and pelvic lymph node dissection. Extensive pelvic surgery can damage innervation of the pelvic organs resulting in urinary,rectal and sexual disorders.Nerve-sparing radical hysterectomy（NSRH） was introduced as one of the treatment option for cervical cancer patient suffer from postoperative complains. Substantial progress has been made in understanding the neuroanatomy of the antonomic pelvic plexus. Nerve sparing technique in laparoendoscopic single-site radical hysterectomy, robotic-assisted radical hysterectomy,minilaparoscopic radical hysterectomy and has made grate progress. Because the nerve fibers of pelvic plexue are distributed in a network,it is difficult to identify with the naked eyes. The inaccuracy of nerve preservation restricts the standardization and promotion of surgery. Intraoperation neurelectrophysiological monitoring may be a new development direction of nerve-sparing hysterectomy.