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[宫颈癌患者保留神经的根治性子宫切除术的前瞻性研究]

[A prospective study on nerve-sparing radical hysterectomy in patients with cervical cancer].

作者信息

Li Bin, Zhang Rong, Wu Ling-Ying, Zhang Gong-Yi, Li Xian, Yu Gao-Zhi

机构信息

Department of Gynecological Oncology, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2008 Aug;43(8):606-10.

Abstract

OBJECTIVE

To assess the nerve-sparing radical hysterectomy (NSRH) technique and its impact on postoperative voiding function.

METHODS

Forty-four patients with International Federation of Gynecology and Obstetrics (FIGO) stage I b1-IIa cervical cancer were enrolled and randomized into NSRH group (study group, n = 22) and conventional radical hysterectomy (CRH) group (control group, n = 22). The pelvic autonomic nerve pathway (including hypogastric nerve, pelvic splanchnic nerve, inferior hypogastric plexus and bladder branch) was completely preserved in the NSRH group. Related parameters were compared between the two groups.

RESULTS

The estimated blood loss in NSRH group and CRH group were (550 +/- 241) ml and (475 +/- 284) ml, respectively, with no significant difference (P > 0.05). The mean operation time in NSRH group and CRH group were (329 +/- 43) min and (272 +/- 56) min, respectively, with a significant difference (P < 0.01). More patients in NSRH group had post-void residual urine volume (PVR) < 100 ml than that in CRH group on day 8 after surgery (68% vs. 18%, P < 0.01). The median duration of postoperative catheterization was significantly shorter in NRSH group (8 - 23 days, median 8 days) than that in CRH group (8 - 32 days, median 20 days; P < 0.01). Neither surgery-related injury nor pathologically positive margin was reported in either of the groups.

CONCLUSIONS

NSRH is a feasible and safe technique for preserving bladder function. Larger prospective studies are needed to confirm the efficacy of this technique.

摘要

目的

评估保留神经的根治性子宫切除术(NSRH)技术及其对术后排尿功能的影响。

方法

纳入44例国际妇产科联盟(FIGO)分期为Ib1-IIa期的宫颈癌患者,随机分为NSRH组(研究组,n = 22)和传统根治性子宫切除术(CRH)组(对照组,n = 22)。NSRH组完全保留盆腔自主神经通路(包括腹下神经、盆内脏神经、下腹下丛和膀胱支)。比较两组的相关参数。

结果

NSRH组和CRH组的估计失血量分别为(550±241)ml和(475±284)ml,差异无统计学意义(P>0.05)。NSRH组和CRH组的平均手术时间分别为(329±43)分钟和(272±56)分钟,差异有统计学意义(P<0.01)。术后第8天,NSRH组术后残余尿量(PVR)<100 ml的患者多于CRH组(68%对18%,P<0.01)。NSRH组术后留置导尿管的中位时间明显短于CRH组(8 - 23天,中位时间8天)(8 - 32天,中位时间20天;P<0.01)。两组均未报告手术相关损伤或病理切缘阳性。

结论

NSRH是一种保留膀胱功能可行且安全的技术。需要更大规模的前瞻性研究来证实该技术的疗效。

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