CAJ | 학술논문

目的初步探讨保留一侧或两侧盆腔神经的广泛性子官切除术的可行性和对术后膀胱直肠功能恢复的评估.方法选择2008年8月至2009年10月浙江省肿瘤医院妇瘤科收治的61例Ⅰb1～Ⅱa期子宫颈癌患者,其中28例行保留盆腔神经的子宫广泛性切除术(NSRH),33例行传统的子宫广泛性切除术(RH).NSRH组中,有10例患者行保留一侧盆腔神经手术(UNSRH),18例患者行保留两侧盆腔神经手术(BNSRH).分别监测NSRH和RH的手术时间、手术出血量及术后并发症,观察手术对膀胱和直肠功能恢复的影响.结果 NSRH组的手术时间、手术出血量、术后住院时间和残余尿量分别为(224.5±40.0)min、(464.3±144.0)ml、(8.4±2.0)d和(64.8±16.9)ml,RH组分别为(176.4±30.0)min、(374.2±138.7)ml、(9.2±1.8)d和(70.6±16.0)ml,差异均无统计学意义(均P>0.05).UNSRH组的手术时间、手术出血量、术后住院时间和残余尿量分别为(208.5±28.5)min、(440.0±104.9)ml、(9.1±1.8)d、(68.3±12.5)ml,BNSRH组分别为(233.3±43.1)min、(477.8±162.9)ml、(8.7±2.1)d和(62.8±20.0)ml,两组差异均无统计学意义(均P>0.05).NSRH组术后留置膀胱造痿管时间为(12.4±5.2)d,RH组为(22.4±9.7)d,差异有统计学意义(P<0.05).BNSRH组术后留置膀胱造瘘管时间为(9.1±2.0)d,UNSRH组为(18.2±3.6)d,差异有统计学意义(P<0.05).术后3周,NSRH组的排尿和排便满意度分别为100%和75.0%,RH组分别为54.5%和24.2%,差异均有统计学意义(均P<0.05).结论保留一侧或两侧盆腔自主神经的广泛性子宫切除术对治疗早期宫颈癌是安全可行的,此手术方式能有效地改善术后膀胱功能及直肠功能恢复.
목적 초보탐토보류일측혹량측분강신경적엄범성자관절제술적가행성화대술후방광직장공능회복적평고.방법 선택2008년8월지2009년10월절강성종류의원부류과수치적61례Ⅰb1～Ⅱa기자궁경암환자,기중28례행보류분강신경적자궁엄범성절제술(NSRH),33례행전통적자궁엄범성절제술(RH).NSRH조중,유10례환자행보류일측분강신경수술(UNSRH),18례환자행보류량측분강신경수술(BNSRH).분별감측NSRH화RH적수술시간、수술출혈량급술후병발증,관찰수술대방광화직장공능회복적영향.결과 NSRH조적수술시간、수술출혈량、술후주원시간화잔여뇨량분별위(224.5±40.0)min、(464.3±144.0)ml、(8.4±2.0)d화(64.8±16.9)ml,RH조분별위(176.4±30.0)min、(374.2±138.7)ml、(9.2±1.8)d화(70.6±16.0)ml,차이균무통계학의의(균P>0.05).UNSRH조적수술시간、수술출혈량、술후주원시간화잔여뇨량분별위(208.5±28.5)min、(440.0±104.9)ml、(9.1±1.8)d、(68.3±12.5)ml,BNSRH조분별위(233.3±43.1)min、(477.8±162.9)ml、(8.7±2.1)d화(62.8±20.0)ml,량조차이균무통계학의의(균P>0.05).NSRH조술후류치방광조위관시간위(12.4±5.2)d,RH조위(22.4±9.7)d,차이유통계학의의(P<0.05).BNSRH조술후류치방광조루관시간위(9.1±2.0)d,UNSRH조위(18.2±3.6)d,차이유통계학의의(P<0.05).술후3주,NSRH조적배뇨화배편만의도분별위100%화75.0%,RH조분별위54.5%화24.2%,차이균유통계학의의(균P<0.05).결론 보류일측혹량측분강자주신경적엄범성자궁절제술대치료조기궁경암시안전가행적,차수술방식능유효지개선술후방광공능급직장공능회복.
Objective To investigate the feasibility of unilateral or bilateral nerve-sparing radical hysterectomy and evaluate the recovery of bladder and bowel function postoperatively.Methods From August 2008 to October 2009, sixty-one patients with cervical cancer stage Ⅰ b1 to Ⅱ a underwent radical hysterectomy ( 33 cases) and nerve-sparing radical hysterectomy ( 28 cases).Unilateral nerve-sparing radical hysterectomy was performed in 10 patients, and bilateral nerve-sparing radical hysterectomy (BNS) was performed in 18 patients.The data of operation time, blood loss, postoperative hospital stay days, residual urine volume, and postoperative complications were collected.The postoperative recovery of bladder and bowel function was evaluated.Results There were no significant differences between nerve-sparing radical hysterectomy (NSRH) and radical hysterectomy ( RH ) groups in operation time [NSRH:( 224.5±40.0 )min,RH:(176.4 ±30.0 min)], blood loss [NSRH:(464.3±144.0) mi,RH:(374.2±138.7) ml],postoperative hospital stay days [NSRH:(8.4 ± 2.0 ) d, RH:(9.2 ± 1.8 ) d, and residual urine volume [NSRH:(64.8 ± 16.9) mi, RH:(70.6 ± 16.0) ml].There were also no significant differences betweenUNSRH and BNSRH groups in operation time [UNSRH:(208.5±28.5 ) min, BNSRH:(233.3±43.1 )min], blood loss [UNSRH:(440.0±104.9) ml, BNSRH:( 477.8±62.90) ml], postoperative hospital stay days [UNSRH:9.1±1.8) d, BNSRH:(8.7±2.1d], and the residual urine volume [UNSRH:(68.3±12.5) ml, BNSRH:(62.8±20.0) ml].There was a significant difference in the time of the Foley catheter removal between NSRH [( 12.4±5.2) d] and RH [(22.4 ± 9.7 ) d] groups.There was a significant difference in the time of the Foley catheter removal between UNSRH [( 18.2±3.6) d] and BNSRH [(9.1±2.0)d] groups.During the postoperative 3 weeks follow-up, the patients in the NSRH group had a higher rate of satisfaction at urination and defecation ( 100%, 75% ) than the RH group (54.5%,24.2% ).Conclusion UNSRH and BNSRH are safe and feasible techniques for early stage cervical cancer, and may significantly improve the recovery of bladder and rectal function.