Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing 400038, PR China.
Gynecol Oncol. 2010 Nov;119(2):202-7. doi: 10.1016/j.ygyno.2010.06.033. Epub 2010 Aug 2.
The objectives of this study were to describe our laparoscopic nerve-sparing radical hysterectomy (LNSRH) technique and to assess the feasibility and safety of the procedure, as well as its impact on voiding function. We introduce a fascia space dissection technique in order to preserve the pelvic splanchnic nerve, the hypogastric nerve and the bladder branch of the inferior hypogastric plexus under magnification (×10.5) during laparoscopic radical hysterectomy (LRH) with pelvic lymphadenectomy.
From October 2006 to November 2009, 163 consecutive patients with cervical cancer underwent laparoscopic radical hysterectomy (LRH) and pelvic lymphadenectomy, with 82 women undergoing LNSRH with fascia space dissection technique (LNSRH group) and 81 undergoing LRH (LRH group). Data from 163 patients were prospectively collected and compared. Post-operative assessment of bladder function included the following: the time to recover the ability to void spontaneously and to achieve a post-void residual urine (PVR) volume of less than 50 ml, with urination function graded.
The laparoscopic nerve-sparing radical hysterectomy procedure was completed successfully and was conducted safely in all of the patients. There were no conversions to open surgery in the two groups. The median operative duration in the LNSRH and the LRH groups were 163.52±34.47 min and 132.13±31.42 min, respectively. Blood loss was 142.12±62.38 ml and 187.69±68.63 ml, respectively. The time taken to obtain a post-void residual urine volume of less than 50 ml after removal of the urethral catheter was 7.42±2.35 d (5-18 d) in LNSRH group and was 16.75±7.73 d (5-35 d) in LRH group (P<0.05). The bladder void function recovery to Grades 0-I was 76 (92.7%) for the LNSRH group and 59 (72.8%) for the LRH group. A mean follow-up of 22.3 (5-42) months was adhered to, and no patient had a recurrence or metastasis.
The technique described in this preliminary study appears to be safe, feasible, and easy in our population, with satisfactory recovery of voiding function.
本研究的目的是描述我们的腹腔镜下保留神经的根治性子宫切除术（LNSRH）技术，并评估该手术的可行性和安全性，以及对排尿功能的影响。我们在腹腔镜根治性子宫切除术（LRH）和盆腔淋巴结切除术时引入了一种筋膜间隙解剖技术，以便在放大（×10.5）下保留盆腔内脏神经、下腹神经和下腹腔下丛的膀胱分支。
从 2006 年 10 月至 2009 年 11 月，连续 163 例宫颈癌患者接受了腹腔镜根治性子宫切除术（LRH）和盆腔淋巴结切除术，其中 82 例患者接受了筋膜间隙解剖技术的 LNSRH（LNSRH 组），81 例患者接受了 LRH（LRH 组）。前瞻性收集了 163 例患者的数据并进行了比较。术后膀胱功能评估包括：恢复自主排尿能力的时间和达到残余尿（PVR）量<50ml 的时间，排尿功能分级。
腹腔镜下保留神经的根治性子宫切除术在所有患者中均成功完成，且安全。两组均无中转开腹手术。LNSRH 组和 LRH 组的中位手术时间分别为 163.52±34.47min 和 132.13±31.42min。术中出血量分别为 142.12±62.38ml 和 187.69±68.63ml。LNSRH 组拔除导尿管后获得残余尿<50ml 的时间为 7.42±2.35d（5-18d），LRH 组为 16.75±7.73d（5-35d）（P<0.05）。LNSRH 组膀胱排空功能恢复至 0-I 级的有 76 例（92.7%），LRH 组为 59 例（72.8%）。随访时间平均为 22.3（5-42）个月，无患者复发或转移。
在我们的人群中，本研究初步描述的技术似乎是安全、可行且易于操作的，并且排尿功能恢复良好。
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