腹腔镜下保留盆腔神经广泛子宫切除术及盆腔淋巴结清扫术治疗宫颈癌(ⅠA2~ⅠB1期)患者疗效观察

Efficacy of laparoscopic nerve sparing radical hysterectomy and pelvic lymph node dissection in the treatment of stageⅠA2~ⅠB1 cervical cancer

目的研究腹腔镜下保留盆腔自主神经广泛子宫切除术(LNSRH)及盆腔淋巴结清扫术治疗宫颈癌(ⅠA2~ⅠB1期)患者的疗效。方法收集2017年1月至2021年6月于河南省平顶山市第一人民医院进行手术治疗的90例宫颈癌(ⅠA2~ⅠB1期)患者临床资料,根据术中是否保留盆腔神经将90例患者分为LNSRH组(A组,n=42)和普通腹腔镜下广泛性子宫切除术组(LRH组,B组,n=48),比较两组的手术情况、术后恢复情况、不良反应或并发症、生活质量、性生活质量等。结果A组肛门排气时间、留置导尿时间、住院时间均短于B组(P<0.05);A组尿失禁、尿潴留发生率均小于B组(P<0.05);术后6个月,两组最大尿流率、最大逼尿肌收缩压、膀胱顺应性均降低(P<0.05),但A组上述指标高于B组(P<0.05);两组术后生活质量评分均降低,但A组评分高于B组(P<0.05);术后6个月,两组性生活质量评分与术前比较差异均有统计学意义(P<0.05),A组在“性生活相关困扰”“性活跃度”“性生活愉悦感”等维度评分优于B组(P<0.05)。结论LNSRH及盆腔淋巴结清扫术治疗宫颈癌(ⅠA2~ⅠB1期)可改善患者术后恢复情况、膀胱功能及生活质量,有利于疾病恢复,是一种有效、安全、可行的手术方式,值得在临床治疗中推广使用。

Objective To study the efficacy of laparoscopic nerve sparing radical hysterectomy(LNSRH)and pelvic lymph node dissection in the treatment of cervical cancer(stageⅠA2~ⅠB1).Methods The clinical data of 90patients with cervical cancer(stageⅠA2~ⅠB1)who came to the hospital for surgical treatment were collected between January 2017 and June 2021.According to whether the pelvic nerve was preserved during surgery,the 90 patients were divided into LNSRH group(group A,n=42)and general laparoscopic radical hysterectomy group(LRH group,group B,n=48).The surgical status,postoperative recovery status,adverse reactions or complications,quality of life and sexual life quality were compared between the two groups of patients.Results The anal exhaust time,indwelling catheterization time and hospital stay in group A were shorter than those in group B(P<0.05).The incidence rates of urinary incontinence and urinary retention were lower in group A than those in group B(P<0.05).At 6 months after surgery,the maximum urinary flow rate,maximum detrusor systolic pressure and bladder compliance were all declined in the two groups(P<0.05),but the above indicators of patients in group A were higher compared with those in group B(P<0.05).The quality of life scores after surgery in both groups were lowered,but the score in group A was higher compared to group B(P<0.05).At 6 months after surgery,the scores of sexual life quality in the two groups were significantly different from those before surgery(P<0.05),but the scores of dimensions of“sexual life-related troubles”,“sexual activity”and“sexual pleasure”were better in group A compared to group B(P<0.05).Conclusions LNSRH and pelvic lymph node dissection for the treatment of stageⅠA2~ⅠB1 cervical cancer can improve the postoperative recovery status,bladder function and quality of life of patients,and it is conducive to disease recovery.It is an effective,safe and feasible surgical method,and worthy of promotion and application in clinical treatment.