改良式输尿管隧道处理方法在宫颈癌QM-C1型子宫切除术中的临床研究

Clinical study of modified ureteral tunnel treatment in QM-C1 hysterectomy for cervical cancer

目的探讨改良式输尿管隧道处理方法在行QM-C1型子宫切除术中的可行性及安全性。方法选择2015年10月到2017年10月期间在佛山市南海区人民医院行改良式输尿管隧道处理法的34例宫颈癌患者为研究组,同期行传统方法的32例宫颈癌患者作为对照组。比较两组手术时间、术中出血量及尿管留置时间等围手术期相关参数;比较两组主韧带、骶韧带及阴道切除长度,淋巴结切除个数等情况;对输尿管损伤的发生率及其他并发症发生情况进行比较。结果改良组的中位手术时间241 min和术中出血量(49±9)mL明显少于传统组的中位手术时间248.0 min和术中出血量(57±10)mL,两组之间差异均有统计学意义(P<0.05)。两组术后尿管留置时间分别为(7.5±0.8)d和(7.4±1)d,两组比较差异无统计学意义(P>0.05)。两组在主韧带、骶韧带、阴道切除长度、切除淋巴结个数方面以及在术中、术后并发症发生率之间的差异均无统计学意义(P>0.05)。结论改良式输尿管隧道处理方法缩短了手术时间,减少了术中出血量,利于患者术后的恢复,但未降低输尿管损伤及其他并发症的发生率。在宫颈癌QM-C1型子宫切除术中的使用是安全可行的,有临床应用及推广的意义。

Objective To explore the feasibility and safety of modified ureteral tunnel treatment in QM-C1 hysterectomy for cervical cancer.Methods 34 patients with cervical cancer who underwent modified ureteral tunnel treatment in Nanhai People's Hospital from October 2015 to October 2017 were selected as the study group,and 32 patients with cervical cancer who underwent traditional treatment in the same period were selected as the control group.The operation time,intraoperative bleeding volume and indwelling time of ureter were compared between the two groups.The length of main ligament,sacral ligament and vaginal resection,and the number of lymph node resection were compared between the two groups.The incidence of ureteral injury and other complications were also compared.Results The median operation time of the study group was shorten than the control group(241.0 min vs 248.0 min),the intraoperative bleeding volume of the study group was less than the control group[(49±9)mL vs(57±10)mL],both differences were significant(P<0.05).The indwelling time of urinary catheter of the two groups were(7.5±0.8)d and(7.4±1)d,and there was no significant difference between the two groups(P>0.05).There was no significant difference in the length of main ligament,sacral ligament and vaginal resection,the number of lymph nodes resected and the incidence of complications during and after operation between the two groups(P>0.05).Conclusions The improved ureteral tunnel treatment method could shorten the operation time,reduce the amount of intraoperative bleeding,and it is conducive to the recovery of patients after operation,but could not reduce the incidence of ureteral injury and other complications.The application of QM-C1 hysterectomy for cervical cancer is safe and feasible,and has the significance of clinical application and promotion.