CAJ | 학술논문

目的：评价腹腔镜下保留盆腔自主神经广泛性子宫切除术治疗早期宫颈癌的临床效果。方法选取本院2011年4月至2014年2月收治的178例早期宫颈癌患者为研究对象，按照随机数表法将其分为研究组和对照组，每组各89例。研究组患者行保留盆腔自主神经的腹腔镜下广泛子宫切除术。对照组患者行常规腹腔镜广泛子宫切除术。对比两组患者手术资料、治疗前后尿流动力学变化、远期尿失禁及性生活质量评分。结果研究组患者手术时间显著长于对照组（P＜0.05），术后住院时间显著少于对照组（P＜0.05），两组患者淋巴结扫清数量、宫旁及阴道切除长度比较均无显著差异（P＞0.05）。两组患者治疗前尿流动力学各指标比较均无显著差异（P＞0.05），治疗后两组各指标均较治疗前显著变化（P＜0.05），研究组变化幅度显著低于对照组（P＜0.05）。两组患者治疗前尿失禁生活质量量表（I-QOL）评分比较无显著差异（P＞0.05），术后3个月较治疗前均显著下降（P＜0.05），术后1年较术后3个月显著回升（P＜0.05）。研究组患者术后3个月及术后1年I-QOL评分均显著高于对照组（P＜0.05）。两组治疗前女性性功能量表（FSFI）各评分及总评分比较均无显著差异（P＞0.05），治疗后较治疗前均显著下降（P＜0.05），研究组患者下降幅度显著低于对照组（P＜0.05）。结论腹腔镜下保留盆腔自主神经广泛性子宫切除术治疗早期宫颈癌，虽然手术流程更为复杂，但能显著减轻患者术后膀胱功能损伤，提高患者术后生活质量，值得临床推广应用。
목적：평개복강경하보류분강자주신경엄범성자궁절제술치료조기궁경암적림상효과。방법선취본원2011년4월지2014년2월수치적178례조기궁경암환자위연구대상，안조수궤수표법장기분위연구조화대조조，매조각89례。연구조환자행보류분강자주신경적복강경하엄범자궁절제술。대조조환자행상규복강경엄범자궁절제술。대비량조환자수술자료、치료전후뇨류동역학변화、원기뇨실금급성생활질량평분。결과연구조환자수술시간현저장우대조조（P＜0.05），술후주원시간현저소우대조조（P＜0.05），량조환자림파결소청수량、궁방급음도절제장도비교균무현저차이（P＞0.05）。량조환자치료전뇨류동역학각지표비교균무현저차이（P＞0.05），치료후량조각지표균교치료전현저변화（P＜0.05），연구조변화폭도현저저우대조조（P＜0.05）。량조환자치료전뇨실금생활질량량표（I-QOL）평분비교무현저차이（P＞0.05），술후3개월교치료전균현저하강（P＜0.05），술후1년교술후3개월현저회승（P＜0.05）。연구조환자술후3개월급술후1년I-QOL평분균현저고우대조조（P＜0.05）。량조치료전녀성성공능량표（FSFI）각평분급총평분비교균무현저차이（P＞0.05），치료후교치료전균현저하강（P＜0.05），연구조환자하강폭도현저저우대조조（P＜0.05）。결론복강경하보류분강자주신경엄범성자궁절제술치료조기궁경암，수연수술류정경위복잡，단능현저감경환자술후방광공능손상，제고환자술후생활질량，치득림상추엄응용。
ObjectiveTo evaluate the clinical effect of systematic nerve sparing radical hysterectomy in the treatment of early cervical cancer under the laparoscope.Method178 patients with early cervical cancer treated in our hospital from April 2011 to February 2014 were chose as objects of study and were randomly divided into study group and control group, 89 cases in each group. Study group were given the systematic nerve sparing radical hysterectomy under the laparoscope. Control group were given conventional laparoscopic extensive hysterectomy. The surgical data, change in the urodynamics before and after treatment, long-term urinary incontinence and score for quality of life were compared between the two groups.Result The operative length for patients in the study group was signiifcantly higher than control group (P<0.05), postoperative hospitalization time signiifcantly lower than that control group (P<0.05), but no signiifcant differences in lymph node clearing quantity, uterine and vaginal resection length between the two groups (P>0.05). There was no signiifcant difference in indicators of urodynamics between the two groups before treatment (P>0.05), and the indicators in two groups were significantly worsened after the treatment (P<0.05). The progression for patients in study group was signiifcantly lower than control group (P<0.05). There was no signiifcant difference in I-QOL score between the two groups before treatment (P>0.05), postoperative 3-month I-QOL score compared with the one before treatment was significantly decreased (P<0.05), postoperative 1-year I-QOL score was signiifcantly increased than the postoperative 3-month one (P<0.05), but there was still no signiifcant difference between ones before and after the treatment (P<0.05). The I-QOL score in study group was signiifcantly better than control group (P<0.05) at 3 months and 1 year after surgery. There were no signiifcant differences in the score of life quality and total scores between the two groups before the treatment (P>0.05). The scores of all indicators and the total scores of the two groups were signiifcantly lower than those after the treatment (P<0.05). The progression for patients in study group was signiifcantly lower than control group (P<0.05).ConclusionThough the operation process of systematic nerve sparing radical hysterectomy under laparoscope in the treatment of early cervical cancer is more complicated, it is capable to signiifcantly relieve the postoperative injured function of bladder and promote the quality of life for patients after the operation, worthy to be popularized in the clinical practice.