Zullo Marzio Angelo, Manci Natalina, Angioli Roberto, Muzii Ludovico, Panici Pierluigi Benedetti
Department of Gynecology, Free University Campus Biomedico, via Longoni, 83-00155 Rome, Italy.
Crit Rev Oncol Hematol. 2003 Dec;48(3):287-93. doi: 10.1016/s1040-8428(03)00125-2.
Functional disorders of the lower urinary tract are the most common long-term complications following radical surgery for cancer of the uterine cervix (8-80%). These disturbances were associated to the partial interruption of the autonomic fibers innervating the bladder during the resection of anterior, lateral and posterior parametrium and vaginal cuff. The pathophysiology of these changes is actually debated. The nature of the surgical damage appears to be a decentralization rather than a complete denervation and bladder dysfunctions may be either the unmasking of intrinsic detrusor activity, characterized by a loss of beta-adrenergic innervation and a consequent alfa-adrenergic hyperinnervation or the influence of remaining sympathetic innervation. No data on long-term bladder function in patients who underwent class 4 radical hysterectomy have been reported. In our experience on long-term vesical function in 38 patients with locally advanced cervical cancer treated with neoadjuvant chemotherapy and 4 Piver type radical hysterectomy, urinary symptoms were reported in 11 patients (29%), while a normal urodynamic finding was recorded in only nine patients (24%). The most common bladder dysfunction was the storage dysfunction (47%). The voiding dysfunction was present in one patient (3%) and stress urinary incontinence in 20 patients (53%). The parametrial and vaginal resections were compared among the urodynamic diagnosis The size of lateral parametria measured on the giant sections did not differ among the groups of urodynamic diagnosis, while the length of vagina removed was significantly longer in patients with detrusor dysfunctions (storage and voiding dysfunctions) than in patients with normal diagnosis or genuine stress incontinence.
下尿路功能障碍是子宫颈癌根治性手术后最常见的长期并发症（8%-80%）。这些功能紊乱与在切除子宫主韧带前后及阴道断端时支配膀胱的自主神经纤维的部分中断有关。这些变化的病理生理学目前仍存在争议。手术损伤的本质似乎是去神经支配而非完全失神经支配，膀胱功能障碍可能是内在逼尿肌活动的暴露，其特征为β-肾上腺素能神经支配丧失及随之而来的α-肾上腺素能神经支配亢进，也可能是残余交感神经支配的影响。目前尚无关于接受4级根治性子宫切除术患者长期膀胱功能的数据报道。根据我们对38例接受新辅助化疗和4例Piver型根治性子宫切除术的局部晚期宫颈癌患者长期膀胱功能的经验，11例患者（29%）报告有泌尿症状，而仅9例患者（24%）尿动力学检查结果正常。最常见的膀胱功能障碍是储尿功能障碍（47%）。1例患者（3%）存在排尿功能障碍，20例患者（53%）存在压力性尿失禁。对尿动力学诊断结果进行了子宫主韧带和阴道切除术的比较。在巨大切片上测量的子宫主韧带外侧大小在尿动力学诊断组之间无差异，而在逼尿肌功能障碍（储尿和排尿功能障碍）患者中切除的阴道长度明显长于诊断正常或真性压力性尿失禁的患者。
