Querleu Denis, Narducci Fabrice, Poulard Valery, Lacaze Sophie, Occelli Bruno, Leblanc Eric, Cosson Michel
Department of Gynecologic Oncology, University of Lille II, Centre Oscar Lambret, 2 avenue Frédéric Combemale, Lille, 59020, France.
Gynecol Oncol. 2002 Apr;85(1):154-8. doi: 10.1006/gyno.2002.6588.
Nerve-sparing dissection of the lateral portion of the cardinal ligament (paracervical lymphadenectomy) has been recently developed with the goal of reducing the late urinary adverse effects of radical hysterectomy without impairing the outcome. This work has been carried out in order to investigate the influence of additional paracervical lymph node dissection at the time of laparoscopically assisted modified radical hysterectomy on outcome and urinary sequelae.
A total of 95 patients underwent a modified radical hysterectomy using a combined laparoscopic and vaginal approach since 1991. In 47 of these patients treated since 1996 an additional laparoscopic paracervical lymphadenectomy was performed. The operative, postoperative, and survival outcomes were assessed. In 60 patients, 32 and 28 in the groups of patients with or without paracervical dissection, respectively, a careful interview on urinary symptoms was conducted by an independent investigator.
Paracervical dissection involves no operative complication and lenghthens the postoperative urinary retention, but has no adverse influence on long-term urinary discomfort. The yield of paracervical dissection is negligible for small tumors: no positive node was found in 38 patients with tumors less than 2 cm in diameter. The outcome of patients after minimal access surgery for tumors less than 2 cm is excellent whether or not a paracervical dissection has been performed.
Paracervical dissection does not worsen the late urinary symptoms after vaginal radical hysterectomy. It has a limited value in the surgical management of small-size (less than 2 cm) cervical cancers, although it may prevent long-term lateropelvic recurrences.
主韧带外侧部分的保留神经解剖术（宫颈旁淋巴结切除术）最近已得到开展，目的是在不影响手术效果的前提下减少根治性子宫切除术的晚期泌尿系统不良反应。开展这项研究是为了调查在腹腔镜辅助改良根治性子宫切除术时额外进行宫颈旁淋巴结清扫术对手术效果和泌尿系统后遗症的影响。
自1991年以来，共有95例患者采用腹腔镜与阴道联合入路进行改良根治性子宫切除术。其中，1996年以来接受治疗的47例患者额外进行了腹腔镜宫颈旁淋巴结清扫术。对手术、术后及生存结果进行评估。在60例患者中，分别对32例进行了宫颈旁清扫术的患者和28例未进行宫颈旁清扫术的患者，由一名独立调查员就泌尿系统症状进行了详细询问。
宫颈旁清扫术未引发手术并发症，延长了术后尿潴留时间，但对长期泌尿系统不适无不良影响。对于小肿瘤，宫颈旁清扫术的阳性发现率可忽略不计：38例直径小于2 cm的肿瘤患者未发现阳性淋巴结。对于直径小于2 cm的肿瘤，无论是否进行了宫颈旁清扫术，微创手术后的患者预后均良好。
宫颈旁清扫术不会加重阴道根治性子宫切除术后的晚期泌尿系统症状。对于小尺寸（小于2 cm）宫颈癌的手术治疗，其价值有限，尽管它可能预防长期的盆腔侧方复发。
