腹腔镜下C1类宫颈癌根治术治疗早期宫颈癌的临床疗效

Clinical outcomes of laparoscopic type C1 radical hysterectomy in treatment of early cervical cancer

目的探讨腹腔镜下C1类(保留神经)宫颈癌根治术的围术期指标及并发症情况,总结保留神经手术的经验。方法将2015年6月-2018年6月本院妇产科诊治的早期宫颈癌(FIGOⅠB~ⅡA期)患者作为研究对象,采用腹腔镜下C1类宫颈癌根治术者纳入C1类手术组(n=29),采用腹腔镜下C2类宫颈癌根治术者纳入对照组(n=35),比较两组围术期相关指标。结果两组年龄、体质量指数、临床分期、术前置入输尿管支架、淋巴结切除范围、病理类型以及术后辅助治疗情况差异无统计学意义(P> 0.05)。C1类手术组平均住院时间少于对照组[(16.3±2.9) d vs (18.7±4.0) d,P=0.009],手术时间多于对照组[(217.7±62.0) min vs (189.3±54.1) min,P=0.055];两组手术出血量、手术切除范围以及术中与术后感染、淋巴囊肿、泌尿系损伤、肠道损伤发生率差异无统计学意义(P> 0.05)。与对照组比较,C1类手术组术后留置尿管时间更少[(13.9±4.7) d vs(18.5±6.1) d,P=0.002],手术后排气时间更短[(34.1±7.8) h vs (39.5±11.0) h,P=0.030]。结论对于宫颈癌ⅠB~ⅡA期患者,腹腔镜下C1类宫颈癌根治术能够减少对膀胱、直肠的影响,利于术后排尿排便功能恢复。

Objective To investigate the perioperative parameters and complications of laparoscopic type C1(nerve-sparing)radical hysterectomy,and summarize the experience of nerve preservation operation.Methods The cervical cancer patients(FIGOⅠB-ⅡA)diagnosed and treated in our hospital from June 2015 to June 2018 were included in our study.Patients accepted the laparoscopic type C1(nerve-sparing)radical hysterectomy were included in type C1 group(n=29),while the cases undergoing laparoscopic type C2 radical hysterectomy were included in control group(n=35).The perioperative parameters were compared between the two groups.Results There was no significant difference in age,BMI,clinical stage,preoperative placement of ureteral stent,scope of lymphadenectomy,pathological type and postoperative adjuvant therapy between two groups(P>0.05).The average length of hospital stay in the type C1 group were less than those in the control group[(16.3±2.9)d vs(18.7±4.0)d,P=0.009],while the operating time was longer((217.7±62.0)min vs(189.3±54.1)min,P=0.055)No significant difference was found in bleeding volume,surgical resection range,and incidence of complications such as infection,lymphocyst,urinary tract and bowel injury between two groups(P>0.05).Compared with the control group,the type C1 group had less indwelling catheter time[(13.9±4.7)d vs(18.5±6.1)d,P=0.002],shorter exhaust time((34.1±7.8)h vs(39.5±11.0)h,P=0.030)Conclusion For cervical cancer patients in stageⅠB-ⅡA,laparoscopic type C1 radical hysterectomy can reduce postoperative bladder and bowel dysfunction.