腹腔镜下保留盆腔自主神经平面根治性子宫切除术的初步临床研究

摘要

目的 探讨保留盆腔自主神经平面的腹腔镜下根治性子宫切除术的技术要点、可行性及其对降低术后膀胱功能障碍的作用.方法 将2010年1月至2011年5月30例宫颈癌患者分为两组,一组(15例)根据盆腔自主神经的标志性结构行保留“神经平面”法,于腹腔镜下保留盆腔自主神经的根治性子宫切除术(LNSRH),另一组(15例)行腹腔镜下根治性子宫切除术(LRH)作为对照.结果 LNSRH组15例患者中2例因出血较多保留单侧神经,1例为ⅡA期选择性保留病灶对侧盆腔神经,其余成功保留了双侧神经.全组30例患者均顺利完成手术,LNSRH组的手术时间为(301.8±47.6) min,长于LRH组的(178.3±17.0) min(P ＜0.05).术中出血量、术后肠道恢复时间、切除盆腔淋巴结的数目、宫旁和阴道切除范围两组比较差异无统计学意义(P＞0.05).术后LNSRH组的住院时间为(10.9±2.0)d,明显少于LRH组的(15.1±0.8)d(P＜0.05).LNSRH组术后拔除尿管的平均时间为(10.8±3.2)d,明显短于LRH组的(17.4±3.2)d(P ＜0.05).随访3～19个月,全组无复发和转移病例.结论 LNSRH在技术上安全、可行,可明显减少术后膀胱功能障碍,既不降低根治性标准,又有利于患者术后恢复及生活质量提高.%Objective To study the feasibility of laparoscopic pelvic autonomic nerve-plane sparing radical hysterectomy (LN-SRH) technique and its effect on decreasing postoperative bladder dysfunction. Methods From February 2010 to May 2011, 30 consecutive patients with cervical cancer were divided into LNSRH group and laparoscopic radical hysterectomy (LRH) group. We performed 15 LNSRH with the fascia space dissection technique and according to the basic anatomic landmarks of pelvic autonomic nerves and the operating time, operating bleeding and the postoperative recovery of bladder function were assayed. The other 15 patients were in control group under LRH. Results In LNSRH group, 2 cases reserved unilateral nerves for more blood loss, one case of stage II selectively reserved contra-lateral pelvic nerves, and the other patients kept bilateral nerves. Of all the 30 patients were performed successfully. The mean operation time in LNSRH group was (301. 8 ± 47. 6) min, longer than (178. 3 ± 17. 0) min in LRH group (P < 0. 05). No significant differences were observed in terms of the quantity of mean intraoperative blood loss, the recovery time of bowel, numbers of pelvic lymph nodes resected, extent of parametrium and vagina resection between the two groups. The duration of postoperative hospital stay in LNSRH group was (10. 9 ± 2. 0) d, shorter than (15. 1 ± 0. 8) d in LRH group (P < 0. 05). The mean time of catheter removing in LNSRH group was (10. 8 ± 3.2) d, shorter than (17. 4 ± 3. 2) d in LRH group( P < 0. 05). All patients were followed up for 3-19 months with no recurrence and metastasis. Conclusion LNSRH is not only minimal invasive, but also safe, adequate and feasible in our population with satisfactory recovery of voiding function. It can also improve the quality of life of patients with cervical cancer.