Uccella Stefano, Laterza Rosa, Ciravolo Giuseppe, Volpi Eugenio, Franchi Massimo, Zefiro Francesca, Donadello Nicoletta, Ghezzi Fabio
Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi 1, 21100 Varese, Italy.
Gynecol Oncol. 2007 Oct;107(1 Suppl 1):S147-9. doi: 10.1016/j.ygyno.2007.07.027. Epub 2007 Aug 27.
The objective of this study was to compare total laparoscopic radical hysterectomy (TLRH) and laparoscopic pelvic lymphadenectomy (LPS) to total abdominal radical hysterectomy (TARH) and pelvic lymphadenectomy (LPT) in terms of urinary tract lesions and postoperative urinary retention.
Starting in 2004, we treated all early stage cervical cancer patients with TLRH and LPS. The control group for this analysis was a historical cohort of patients treated with TARH+LPT. Within the TLRH+LPS group, we assessed whether the width of parametrial tissue removed was a risk factor for urinary tract injuries or postoperative urinary retention.
Fifty women were included in the TLRH+LPS group and forty-eight were included in the TARH+LPT group. There were no conversions from laparoscopy to laparotomy. There was no statistically significant difference in intraoperative urinary complications between the groups. Four (8%) intraoperative urinary tract injuries in the LPS (3 cystotomies and 1 ureteral lesions all repaired laparoscopically) and 2 (4.2%) in the LPT group (2 cystotomies) occurred (p=0.68). Similarly, there was no statistically significant difference in postoperative urinary complications between groups. Urinary postoperative complications were: 1 (2%) ureterovaginal and 1 vesicovaginal fistulas, 1 delayed ureteric fistula in LPS group vs. 0 in LPT group (p=0.24). Urinary retention was complained by 7 (14%) and 7 (14.6%) patients in LPS and LPT groups respectively (p=1.00). The average width of parametrial tissue removed in the LPS group was 32.2+14.0 mm in patients with vs. 39.5+13.6 mm in patients without urinary complications (p=0.11).
A laparoscopic approach is comparable to the laparotomy in terms of urinary lesions and postoperative retention. The width of parametrium removed does not affect the risk of urinary lesions or postoperative retention.
本研究旨在比较全腹腔镜根治性子宫切除术（TLRH）及腹腔镜盆腔淋巴结清扫术（LPS）与经腹根治性子宫切除术（TARH）及盆腔淋巴结清扫术（LPT）在尿路损伤及术后尿潴留方面的情况。
自2004年起，我们采用TLRH及LPS治疗所有早期宫颈癌患者。本分析的对照组为接受TARH+LPT治疗的历史队列患者。在TLRH+LPS组中，我们评估所切除宫旁组织的宽度是否为尿路损伤或术后尿潴留的危险因素。
TLRH+LPS组纳入50名女性，TARH+LPT组纳入48名女性。无腹腔镜转为开腹手术的情况。两组术中尿路并发症无统计学显著差异。LPS组发生4例（8%）术中尿路损伤（3例膀胱切开术和1例输尿管损伤均经腹腔镜修复），LPT组发生2例（4.2%）（2例膀胱切开术）（p=0.68）。同样，两组术后尿路并发症无统计学显著差异。术后尿路并发症为：LPS组1例（2%）输尿管阴道瘘和1例膀胱阴道瘘、1例延迟性输尿管瘘，LPT组为0例（p=0.24）。LPS组和LPT组分别有7例（分别为14%和14.6%）患者主诉尿潴留（p=1.00）。LPS组有尿路并发症患者所切除宫旁组织的平均宽度为32.2+14.0mm，无尿路并发症患者为39.5+13.6mm（p=0.11）。
在尿路损伤及术后尿潴留方面，腹腔镜手术方法与开腹手术相当。所切除宫旁组织的宽度不影响尿路损伤风险或术后尿潴留。
