保留神经的 III-IV 级广泛性子宫切除术：尿动力学研究和手术技术。

Nerve-sparing class III-IV radical hysterectomy: urodynamic study and surgical technique.

机构信息

Department of Gynecology and Obstetrics, S. Maria Goretti Hospital, Latina, Italy.

出版信息

Int J Gynecol Cancer. 2012 May;22(4):675-80. doi: 10.1097/IGC.0b013e3182473256.

DOI:10.1097/IGC.0b013e3182473256

PMID:22367368

Abstract

OBJECTIVE

The aim of this study was to demonstrate the impact of the nerve-sparing radical hysterectomy on the bladder function.

METHODS

Patients with cervical cancer stage 1B1 to IIB, who underwent type 3 to 4 nerve-sparing radical hysterectomy, were evaluated with urodynamic test before and within 6 months from surgery. Stage IB2 to IIB patients were treated with platinum-based neoadjuvant chemotherapy. Bladder catheter was removed in postoperative day 4, and patients were educated to clean intermittent self-catheterization. Urinary symptoms were evaluated with a questionnaire administered before and 3, 6, and 12 months after surgery. Patients treated with adjuvant chemoradiotherapy were excluded from the study.

RESULTS

Fifteen patients (stage IB1, 7; IB2, 3; and IIB, 5) completed the study. Eight (53%) patients were treated with neoadjuvant chemotherapy. Bilateral nerve sparing was feasible in 13 (87%) patients, unilateral in 2 (13%). At postoperative day 10, only 3 (20%) patients continued intermittent self-catheterization. Before surgery, 1 (6.2%) patient had urodynamic symptoms of incontinence, and 3 (20%) had overactive bladder detrusor. Postoperative urodynamic study (median, 4 months; range, 3-6) showed reduced detrusor activity in 8 (53%), overactive detrusor in 4 (27%), and normal profile in 3 (20%) patients. Reduced bladder sensation was observed in 2 (12.5%), and residual urine more than 30% of bladder capacity in 2 (12.5%) patients, respectively. No patient showed de novo incontinence. Bladder compliance was unchanged.

CONCLUSIONS

The separation of the hypogastric nerve from the parametrium is a feasible surgical step, which can be implemented in the radical hysterectomy technique in different clinical settings. The comparative urodynamic study showed a mild functional impairment in the early postoperative period. The most frequent finding was the reduced detrusor activity observed during the voiding phase, consistent with the straining needed to void reported in the questionnaire. These data suggest that a mild bladder impairment occurs despite the conservation of the hypogastric nerve.

摘要

目的

本研究旨在展示保留神经的根治性子宫切除术对膀胱功能的影响。

方法

对接受 3 型至 4 型保留神经根治性子宫切除术的宫颈癌ⅠB1 期至ⅡB 期患者，在术前和术后 6 个月内进行尿动力学检查。ⅠB2 期至ⅡB 期患者接受含铂新辅助化疗。术后第 4 天拔除膀胱导管，对患者进行清洁间歇性自家导尿教育。在术前和术后 3、6 和 12 个月通过问卷调查评估尿症状。排除接受辅助放化疗的患者。

结果

15 例患者（ⅠB1 期 7 例，ⅠB2 期 3 例，ⅡB 期 5 例）完成了研究。8 例（53%）患者接受了新辅助化疗。13 例（87%）患者行双侧神经保留，2 例（13%）行单侧神经保留。术后第 10 天，仅有 3 例（20%）患者继续间歇性自家导尿。术前，1 例（6.2%）患者有尿动力学表现为尿失禁，3 例（20%）患者有逼尿过度性膀胱。术后尿动力学检查（中位数为 4 个月；范围为 3-6 个月）显示 8 例（53%）患者逼尿肌活动减少，4 例（27%）患者逼尿肌过度活动，3 例（20%）患者逼尿肌正常。2 例（12.5%）患者膀胱感觉减退，2 例（12.5%）患者残余尿量超过膀胱容量的 30%。无一例患者出现新发尿失禁。膀胱顺应性无变化。