CAJ | 학술논문

目的：探讨保留盆腔自主神经的腹腔镜广泛子宫切除术（ laparoscopic nerve-sparing radical hysterectomy ， LNSRH）对膀胱和直肠功能恢复的影响。方法选择我院2009年8月～2013年10月宫颈癌ⅠB1～ⅡA期56例、子宫内膜癌Ⅱ期10例，其中LNSRH组36例，腹腔镜广泛子宫切除术（ laparoscopic radical hysterectomy ，LRH）组30例，比较2组膀胱和直肠功能恢复情况。结果与LRH组相比，LNSRH组术后留置尿管时间短[（11．03±2．21） d vs．（18．13±6．00） d， t＝-6．593，P ＝0．000]，术后肛门排气早[（39．97±3．84）h vs．（57．50±4．01） h， t＝-17．969，P＝0．000）。 LNSRH组术后泌尿系统症状及排便异常情况均较LRH组少（P＜0．01），且恢复快。 LNSRH组保留双侧盆腔自主神经（pelvic autonomic nerve， PAN）30例，保留单侧PAN 6例，保留双侧PAN留置尿管时间短[（10．90±1．42） d vs．（13．67±2．42） d， t＝-2．897，P＝0.028]，术后肛门排气早[（39．03±2．55） h vs．（44．33±2．42） h， t＝-4．848，P＝0．002）。尿动力学检测显示，LRH组较LNSRH组术后开始尿意容量和最大膀胱容量增加，最大尿流率和最大逼尿肌压力下降（P＜0．05）。结论 LNSRH安全、可行，可有效降低患者术后膀胱及直肠功能障碍，提高患者的生活质量。
목적：탐토보류분강자주신경적복강경엄범자궁절제술（ laparoscopic nerve-sparing radical hysterectomy ， LNSRH）대방광화직장공능회복적영향。방법선택아원2009년8월～2013년10월궁경암ⅠB1～ⅡA기56례、자궁내막암Ⅱ기10례，기중LNSRH조36례，복강경엄범자궁절제술（ laparoscopic radical hysterectomy ，LRH）조30례，비교2조방광화직장공능회복정황。결과여LRH조상비，LNSRH조술후류치뇨관시간단[（11．03±2．21） d vs．（18．13±6．00） d， t＝-6．593，P ＝0．000]，술후항문배기조[（39．97±3．84）h vs．（57．50±4．01） h， t＝-17．969，P＝0．000）。 LNSRH조술후비뇨계통증상급배편이상정황균교LRH조소（P＜0．01），차회복쾌。 LNSRH조보류쌍측분강자주신경（pelvic autonomic nerve， PAN）30례，보류단측PAN 6례，보류쌍측PAN류치뇨관시간단[（10．90±1．42） d vs．（13．67±2．42） d， t＝-2．897，P＝0.028]，술후항문배기조[（39．03±2．55） h vs．（44．33±2．42） h， t＝-4．848，P＝0．002）。뇨동역학검측현시，LRH조교LNSRH조술후개시뇨의용량화최대방광용량증가，최대뇨류솔화최대핍뇨기압력하강（P＜0．05）。결론 LNSRH안전、가행，가유효강저환자술후방광급직장공능장애，제고환자적생활질량。
Objective To evaluate the effects of laparoscopic pelvic autonomic nerve-sparing radical hysterectomy ( LNSRH) on the recovery of bladder and rectum functions . Methods From August 2009 to October 2013, 56 patients with stage ⅠB1-ⅡA cervical cancer and 10 patients with stage Ⅱendometrial carcinoma were enrolled in this study .The patients were given either LNSRH (36 cases) or laparoscopic radical hysterectomy (LRH) (30 cases).The postoperative bladder and rectum functions was compared between the two procedures . Results The LNSRH group showed significantly shorter time to the removal of Foley catheter than the LRH group [(11.03 ±2.21) d vs.(18.13 ±6.00) d, t=-6.593, P=0.000].The LNSRH group showed significantly shorter time to first exhaust than the LRH group [(39.97 ±3.84) h vs.(57.50 ±4.01) h, t=-17.969, P=0.000].The postoperative urination and defecation anomalies were relatively less in the LNSRH group than those in the LRH group (P<0.01).In the LNSRH group, the pelvic autonomic nerve ( PAN) was preserved bilaterally ( BLNSRH) in 30 patients and unilaterally ( ULNSRH) in 6 patients.There was a significant difference in time to removal of Foley catheter [(10.90 ±1.42) d vs.(13.67 ±2.42) d, t=-2.897, P=0.028] and time to first exhaust [(39.03 ±2.55) h vs.(44.33 ±2.42) h, t=-4.848, P=0.002] between the BLNSRH and ULNSRH groups .The urodynamic study found that there were significant differences between the LRH and LNSRH groups after operation .In the LRH group , the volume of initial urination and the maximum bladder capacity were increased , the maximum urinary flow rate and the maximum detrusor pressure were decreased (P<0.05), respectively. Conclusions LNSRH is safe and feasible.It can diminish the postoperative dysfunctions of bladder and rectum and improve the patients ’ quality of life.