CAJ | 학술논문

目的探讨保留盆腔植物神经的广泛性子宫切除术(NSRH)治疗宫颈癌的可行性,并评估其改善术后膀胱功能的效果.方法选择接受手术治疗的临床分期为Ⅰ b1～Ⅱa期的宫颈癌患者44例,分为两组.研究组22例患者接受NSRH手术,术中在处理主韧带、宫骶韧带、深层的膀胱宫颈韧带及阴道旁组织时,保留盆腔内脏神经、腹下神经、下腹下神经丛及其膀胱支;对照组22例患者接受经典的广泛性子宫切除手术(即Piver Ⅲ类子宫切除术).对比两组患者的术中及术后并发症发生情况.结果研究组术中出血量为(550±241)ml,对照组为(475±284)ml,两组比较,差异无统计学意义(P>0.05);研究组手术时间为(329±43)min,对照组为(272±56)min,两组比较,差异有统计学意义(P<0.01).术后第8天,研究组及对照组中残余尿量<100 ml的患者比例分别为68%及18%,两组比较,差异有统计学意义(P<0.01);研究组留置尿管时间(8～23 d,中位时间8 d)与对照组(8～32 d,中位时间20 d)比较,差异有统计学意义(P<0.01).两组患者均无严重的手术相关性损伤及病理切缘不净的情况发生.结论 NSRH治疗早期子宫颈癌安全、可行,且能明显改善患者术后的膀胱功能.
목적 탐토보류분강식물신경적엄범성자궁절제술(NSRH)치료궁경암적가행성,병평고기개선술후방광공능적효과.방법 선택접수수술치료적림상분기위Ⅰ b1～Ⅱa기적궁경암환자44례,분위량조.연구조22례환자접수NSRH수술,술중재처리주인대、궁저인대、심층적방광궁경인대급음도방조직시,보류분강내장신경、복하신경、하복하신경총급기방광지;대조조22례환자접수경전적엄범성자궁절제수술(즉Piver Ⅲ류자궁절제술).대비량조환자적술중급술후병발증발생정황.결과 연구조술중출혈량위(550±241)ml,대조조위(475±284)ml,량조비교,차이무통계학의의(P>0.05);연구조수술시간위(329±43)min,대조조위(272±56)min,량조비교,차이유통계학의의(P<0.01).술후제8천,연구조급대조조중잔여뇨량<100 ml적환자비례분별위68%급18%,량조비교,차이유통계학의의(P<0.01);연구조류치뇨관시간(8～23 d,중위시간8 d)여대조조(8～32 d,중위시간20 d)비교,차이유통계학의의(P<0.01).량조환자균무엄중적수술상관성손상급병리절연불정적정황발생.결론 NSRH치료조기자궁경암안전、가행,차능명현개선환자술후적방광공능.
Objective To assess the nerve-sparing radical hysterectomy (NSRH) technique and its impact on postoperative voiding function. Methods Forty-fonr patients with International Federation of Gynecology and Obstetrics(FIGO) stage Ⅰ b1 - Ⅱ a cervical cancer were enrolled and randomized into NSRH group ( study group, n = 22) and conventional radical hysterectomy (CRH) group ( control group, n = 22). The pelvic autonomic nerve pathway (including hypogastric nerve, pelvic splanchnic nerve, inferior hypogastric plexus and bladder branch) was completely preserved in the NSRH group. Related parameters were compared between the two groups. Results The estimated blood loss in NSRH group and CRH group were (550±241) ml and (475±284) ml, respectively, with no significant difference (P >0. 05). The mean operation time in NSRH group and CRH group were (329±43) min and (272±56) min, respectively, with a significant difference (P < 0. 01). More patients in NSRH group had post-void residual urine volume (PVR) < 100 ml than that in CRH group on day 8 after surgery (68% vs. 18%, P <0. 01). The median duration of postoperative catheterization was significantly shorter in NRSH group (8 - 23 days, median 8 days) than that in CRH group ( 8 - 32 days, median 20 days; P < 0. 01 ). Neither surgery-related injury nor pathologically positive margin was reported in either of the groups. Conclusions NSRH is a feasible and safe technique for preserving bladder function. Larger prospective studies are needed to confirm the efficacy of this technique.