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目的探讨腹腔镜下保留盆腔自主神经的广泛子宫切除术(laparoscopic nerve-sparing radical hysterectomy,LNSRH)治疗早期宫颈癌的临床价值。方法选取2009年8月至2012年12月于青岛市市立医院,因子宫颈癌行腹腔镜下广泛子宫切除术的患者,采用随机数字表法将其分为两组,其中保留神经组(A组)21例,行腹腔镜下盆腔淋巴清扫(laparoscopic pelvic lymphadenectomy,LPL)+保留盆腔自主神经的广泛子宫切除术(LNSRH),对照组(B组)23例,行腹腔镜下盆腔淋巴清扫(LPL)+子宫广泛切除术(laparoscopic radical hysterectomy,LRH)。比较两组手术时间、术中出血量、手术范围及术后患者膀胱、直肠功能恢复情况。结果 A组20例成功手术,1例因术中处理子宫深静脉及膀胱静脉分支出血损伤神经组织改行LPL+LRH。4例Ⅱa期患者选择性保留病灶对侧盆腔神经,余成功保留双侧神经。A组手术时间较B组延长[(348.25±19.34)min、(273.04±28.87)min],差异有统计学意义(P<0.05),A组肛门排气时间较B组缩短[(38.80±8.33)h、(67.61±8.15)h],差异有统计学意义(P<0.05),A组术后10 d拨尿管率较B组高(60.00%、21.74%)。两组术中出血量、切除主韧带、骶韧带宽度及切除阴道壁长度差异无统计学意义(P>0.05)。结论 LPL+LNSRH作为早期宫颈癌手术治疗方法对改善术后患者尿潴留及肠道功能近期效果良好,远期疗效有待进一步观察。
Objective To investigate the clinical value of laparoscopic nerve-sparing radical hysterectomy (LNSRH) in the treatment of early cervical cancer. Methods From August 2009 to December 2012 in Qingdao Municipal Hospital, patients undergoing laparoscopic radical hysterectomy for cervical cancer were divided into two groups according to a random number table method, in which group A ) Underwent laparoscopic radical lymphadenectomy (LPL) and extensive hysterectomy (LNSRH) with preserving pelvic autonomic nerve. Twenty-three patients in control group (group B) underwent laparoscopic pelvic lymphadenectomy (LPL) ) + Laparoscopic radical hysterectomy (LRH). The operation time, intraoperative blood loss, operative range and postoperative recovery of bladder and rectum were compared between the two groups. Results Twenty patients in group A underwent surgery successfully, and one patient underwent LPL + LRH with nerve tissue remodeling due to intraoperative treatment of deep uterine vein and branch vein hemorrhage. In 4 cases of stage Ⅱ a patients, the pelvic nerves of the opposite side of the lesion were reserved selectively, while the bilateral nerves were reserved successfully. The operative time of group A was longer than that of group B [(348.25 ± 19.34) min, (273.04 ± 28.87) min], the difference was statistically significant (P0.05). The time of anal exhaust in group A was shorter than that of group B [(38.80 ± 8.33) ) h, (67.61 ± 8.15) h], the difference was statistically significant (P <0.05). The dialysis rate in group A at 10 days after operation was higher than that in group B (60.00%, 21.74%). There was no significant difference between the two groups in the amount of bleeding, the removal of the main ligament, the width of the sacral ligament and the length of the vaginal wall resection (P> 0.05). Conclusion LPL + LNSRH as an early surgical treatment for cervical cancer has good effect on improving the postoperative urinary retention and intestinal function. The long-term therapeutic effect needs further observation.