Possover M, Schneider A
Department of Gynecology and Obstetrics, University of Cologne, Kerperner Strasse 34, 50931 Cologne, Germany.
Surg Endosc. 2002 May;16(5):847-50. doi: 10.1007/s00464-001-9082-x. Epub 2002 Feb 8.
This study investigated ways to reduce the rate of slow-transit constipation after radical hysterectomy type III.
A prospective study was conducted involving 59 consecutive patients with cervical cancer stage IB1-IIIA at high risk for parametrial or lymph node involvement who were treated between May 1996 and March 1999 by laparoscopically assisted radical vaginal hysterectomy type III.
During laparoscopic transection of the cardinal ligament, particular attention was focused on conservation of the pelvic splanchnic nerves. After vaginal removal of the uterus, a vaginal sacrocolporectopexy was performed transvaginally. Nerve preservation and pexy of the rectum allowed a significant reduction of postoperative constipation, as compared with classic radical hysterectomy without conservation of the splanchnic pelvic nerves and without sacrocolporectopexy.
Refinements in the preparation of the parasympathetic nerves during radical pelvic surgery and refixation of the terminal rectum helps to prevent postoperative constipation.
本研究探讨了降低III型根治性子宫切除术后慢传输型便秘发生率的方法。
进行了一项前瞻性研究，纳入了1996年5月至1999年3月期间连续59例IB1-IIIA期宫颈癌患者，这些患者存在宫旁或淋巴结受累的高风险，均接受了腹腔镜辅助III型根治性阴道子宫切除术治疗。
在腹腔镜下切断主韧带时，特别注意保留盆腔内脏神经。经阴道切除子宫后，经阴道进行阴道骶骨直肠固定术。与未保留盆腔内脏神经且未行阴道骶骨直肠固定术的经典根治性子宫切除术相比，保留神经和直肠固定术可显著降低术后便秘的发生率。
根治性盆腔手术中副交感神经制备方法的改进以及直肠末端的重新固定有助于预防术后便秘。
