CAJ | 학술논문

目的：客观评价腹腔镜下保留盆腔神经的广泛子宫切除术对膀胱功能的保护效果。方法2009年2月～2011年8月，对43例Ⅰa2～Ⅱa期宫颈癌及24例Ⅱ期子宫内膜癌行腹腔镜下保留盆腔神经的广泛子宫切除术（ laparoscopic nerve-sparing radical hysterectomy ，LNSRH），术前及术后1、6、9、12个月行尿动力学检查，包括尿道测压、膀胱压力容积测定及尿流率测定。结果手术均获成功。手术时间250～310 min，平均260 min；术中出血量50～150 ml，平均80 ml；阴道切除长度3．1～4．3 cm，平均3．5 cm；主韧带切除长度3．0～4．2 cm，平均3．3 cm；宫骶韧带切除长度3．2～3．9 cm，平均3．5 cm。64例术后7 d拔除尿管，残余尿量＜50 ml；3例术后7 d残余尿量＞100 ml，术后14 d恢复至＜50 ml。67例完成术前、术后尿动力学检查，差异均无显著性。术后随访12～44个月，平均35个月，无淋巴囊肿及肿瘤复发、转移，阴道残端均愈合良好。结论 LNSRH安全可行，既能保证疗效，又保证了患者的生活质量。
목적：객관평개복강경하보류분강신경적엄범자궁절제술대방광공능적보호효과。방법2009년2월～2011년8월，대43례Ⅰa2～Ⅱa기궁경암급24례Ⅱ기자궁내막암행복강경하보류분강신경적엄범자궁절제술（ laparoscopic nerve-sparing radical hysterectomy ，LNSRH），술전급술후1、6、9、12개월행뇨동역학검사，포괄뇨도측압、방광압력용적측정급뇨류솔측정。결과수술균획성공。수술시간250～310 min，평균260 min；술중출혈량50～150 ml，평균80 ml；음도절제장도3．1～4．3 cm，평균3．5 cm；주인대절제장도3．0～4．2 cm，평균3．3 cm；궁저인대절제장도3．2～3．9 cm，평균3．5 cm。64례술후7 d발제뇨관，잔여뇨량＜50 ml；3례술후7 d잔여뇨량＞100 ml，술후14 d회복지＜50 ml。67례완성술전、술후뇨동역학검사，차이균무현저성。술후수방12～44개월，평균35개월，무림파낭종급종류복발、전이，음도잔단균유합량호。결론 LNSRH안전가행，기능보증료효，우보증료환자적생활질량。
Objective To evaluate the protective effect of laparoscopic nerve-sparing radical hysterectomy ( LNSRH ) on bladder function. Methods Between February 2009 and August 2011, 43 patients with cervical cancer FIGO stage Ⅰa2-Ⅱa and 24 patients with endometrial carcinoma FIGO stageⅡ underwent LNSRH .These patients participated in urodynamic study including urethral pressure profile (UPP), cystometrography (CMG) and uroflowmetry (UFR).The urodynamic studies were carried out before the surgery and 1, 6, 9, 12 months after the surgery . Results All the surgeries were performed successfully .The operative time was 250-310 min (mean, 260 min);the intraoperative blood loss was 50-150 ml (mean, 80 ml);the length of vaginal resections was 3.1-4.3 cm ( mean, 3.5 cm); the length of cardinal ligament was 3.0-4.2 cm ( mean, 3.3 cm); the length of uterosacral ligament was 3.2-3.9 cm (mean, 3.5 cm).The urethral catheter was removed 7 d postoperatively in all patients and 64 patients had residual urine volume of less than 50 ml.The other three patients had residual urine volume of more than 100 ml after removal of the urethral catheter, which decreased to less than 50 ml at the 14th postoperative day.No significant difference was found in urodynamic study parameter between before and after operation .All patients were followed up for 12 -44 months (mean, 35 months).No postoperative lymphocyst , local recurrence or metastasis was found and the vaginal wound healed up well . Conclusions LNSRH is a safe and feasible technique .The nerve-sparing surgery has good curative effect and yields satisfactory outcomes .