[宫颈癌患者保留神经根治性子宫切除术的初步研究]

[Preliminary study of nerve sparing radical hysterectomy in patients with cervical cancer].

作者信息

Sun Li, Wu Ling-ying, Zhang Wen-hua, Li Xiao-guang, Song Yan, Zhang Xun

机构信息

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

出版信息

Zhonghua Zhong Liu Za Zhi. 2009 Aug;31(8):607-11.

PMID:20021949

Abstract

OBJECTIVE

To assess the feasibility of nerve sparing radical hysterectomy (NSRH) technique and the impact on the improvement of postoperative bladder function in patients with cervical cancer.

METHODS

Forty-two patients with FIGO stage Ib1 approximately Ib2 cervical cancer were selected to receive NSRH (study group, 21 cases) or routine hysterectomy (RH) (control group, 21 cases). Duration of surgery, blood loss and mean length of postoperative stay were compared between the two groups. Immunohistochemical analysis of surgical margins using a general nerve marker (S-100) was performed to compare the nerve damages.

RESULTS

The operation time of NSRH group and RH group was (248 +/- 24) min and (227 +/- 27) min, respectively, with a significant difference between the two groups (P < 0.01). No significant difference in blood loss was found between the NSRH and RH group [(459 +/- 143) ml vs. (454 +/- 121) ml, P > 0.05]. However, the median urinary catheterization time was 7 days in NSRH group versus 16 days in the RH group, with a statistically significant difference between the two groups (P < 0.01). The rate of patients who had postoperative residual urine volume in bladder (PVR) < or =100 ml was 66.7% in the NSRH group versus 19.0% in the RH group, with a significant difference between the two groups (P < 0.01). No severe perioperative complications occurred in both groups. After a follow-up of 11 to 16 months (median: 14 months), no recurrence was detected in the two groups. Immunohistochemistry with S-100 staining revealed only small nerve fibers in the surgical margins of the NSRH group, but full with large nerve bundles in that of the RH group. There was a significant difference between two group (P < 0.01).

CONCLUSION

The results of our preliminary study indicate that nerve sparing radical hysterectomy (NSRH) for the patients with FIGO stage Ib1 approximately Ib2 cervical cancer is safe and feasible, and can well preserve the pelvic autonomic nerves and improve the recovery of bladder voiding function.

摘要

目的

评估保留神经的根治性子宫切除术（NSRH）技术的可行性及其对宫颈癌患者术后膀胱功能改善的影响。

方法

选取42例国际妇产科联盟（FIGO）分期为Ib1至Ib2期的宫颈癌患者，分别接受NSRH（研究组，21例）或常规子宫切除术（RH）（对照组，21例）。比较两组患者的手术时间、出血量及术后平均住院时间。采用通用神经标志物（S-100）对手术切缘进行免疫组化分析，以比较神经损伤情况。

结果

NSRH组和RH组的手术时间分别为（248±24）分钟和（227±27）分钟，两组间差异有统计学意义（P<0.01）。NSRH组与RH组的出血量差异无统计学意义[（459±143）ml对（454±121）ml，P>0.05]。然而，NSRH组的中位导尿时间为7天，而RH组为16天，两组间差异有统计学意义（P<0.01）。NSRH组术后膀胱残余尿量（PVR）≤100ml的患者比例为66.7%，而RH组为19.0%，两组间差异有统计学意义（P<0.01）。两组均未发生严重围手术期并发症。随访11至16个月（中位时间：14个月），两组均未发现复发。S-100染色免疫组化显示，NSRH组手术切缘仅见小神经纤维，而RH组则充满大神经束。两组间差异有统计学意义（P<0.01）。