腹腔镜下广泛性子宫切除术中盆腔自主神经不同处理方式的临床对比

Comparative Study of Different Treatment of Pelvic Autonomic Nerves in Laparoscopic Radical Hysterectomy

目的探讨腹腔镜下广泛性子宫切除术中盆腔自主神经不同处理方式的临床效果。方法选择的对象为2012年5月-2014年5月接受治疗的126例宫颈癌患者,根据患者在腹腔镜下广泛性子宫切除术中盆腔自主神经处理方式的不同将其分为对照组与观察组。对照组患者在腹腔镜广泛切除术中对盆腔神经不做特殊的处理;观察组患者在腹腔镜广泛切除术中保留盆腔自主神经。观察2组患者术中出血量、手术时间、下床活动时间以及住院时间;患者术后排便时间、肛门排气时间、膀胱容量以及拔除尿管时间;手术过程中常见不良反应的发生率。结果治疗后患者的下床活动时间对照组与观察组比较,差异无统计学意义(P>0.05);观察组术中出血量、手术时间以及住院时间都显著低于对照组(P<0.05);观察组患者与对照组患者在术后排便时间、肛门排气时间、膀胱容量以及拔除尿管时间方面进行比较,差异均有统计学意义(P<0.05)。对照组患者手术过程中常见不良反应(泌尿系统感染、手术感染、体重下降、排尿困难、腹部胀气、性功能障碍)的发生率为24.50%,观察组为9.43%,2组差异有统计学意义(P<0.05)。结论腹腔镜下子宫切除术中保留盆腔神经的处理方式与不保留的处理方式相比,可以有效改善患者的手术情况,改善患者的膀胱和直肠功能,降低手术中并发症的发生率,值得对其进行进一步深入研究。

Objective To investigate the clinical efficacy of different treatment of pelvic autonomic nerves in laparoscopic radical hysterectomy. Methods 126 cases of cervical cancer,according to different treatment of pelvic autonomic nerves in laparoscopic radical hysterectomy,were divided into the control group and the observation group. Pelvic autonomic nerves in the control group received no special treatment during laparoscopic resection; pelvic autonomic nerves in the observation group was preserved during laparoscopic resection. Intraoperative blood loss,surgery time,ambulation time,hospitalization time,postoperative defecation,flatus,bladder capacity,catheter removal time,incidence of adverse reactions of the 2 groups were observed. Results Ambulation time in the control group and the observation group after treatment had no significant differences( P > 0. 05); intraoperative blood loss,surgery time,and hospitalization time in the observation group were significantly less than those of the control group,there had significant difference( P < 0. 05); postoperative defecation,flatus,bladder capacity and catheter removal time between the 2 groups had significant difference( P < 0. 05); common adverse reactions in the control group( urinary tract infections,surgical infections,weight loss,difficulty urinating,abdominal bloating,sexual dysfunction) was 24. 50%,and that of the observation group was 9. 43%,the 2 groups had significant difference( P < 0. 05). Conclusion Preservation of pelvic autonomic nerves in laparoscopic radical hysterectomy can effectively improve surgical outcome,bladder and rectum function,reduce the incidence of adverse reactions,and it is worthy of further study.