改良保留神经广泛性子宫切除术后膀胱功能及预后评估
[Evaluation of postoperative bladder function and prognosis after modified nerve sparing radical hysterectomy].
作者信息
Wenwen Wang, Bin Li, Jing Zuo, Gongyi Zhang, Yeduo Yang, Hongmei Zeng, Xiaoguang Li, Lingying Wu
机构信息
Department of Gynecologic Oncology, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China.
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出版信息
Zhonghua Fu Chan Ke Za Zhi. 2014 May;49(5):341-7.
OBJECTIVE
To compare the nerve plane sparing radical hysterectomy (NPSRH) with conventional radical hysterectomy (CRH) in terms of postoperative bladder function and prognosis.
METHODS
One hundred and two patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ib1-IIa2 cervical cancer were treated by open NPSRH (study group) from January 2008 to March 2013. During the same time periods, two hundred and four patients who underwent open CRH were randomly selected as the control group. Age, pathological type and FIGO stage were matched.
RESULTS
The median operation time in NPSRH group and CRH group were 268.8 and 242.4 minutes, respectively (P < 0.01). The median hospital stay were 14.6 and 17.2 days (P < 0.01). The median volume of blood loss in the two groups were respectively 394 and 450 ml (P > 0.05). The blood transfusion rate was respectively 46.1% (47/102) and 41.7% (85/204; P > 0.05). The rate of postoperative complications were not significantly difference [14.7% (15/102) vs 11.8% (24/204), P > 0.05]. The median duration of catheterization was 9.1 and 15.2 days between two groups (P < 0.01). Eighty-five patients in NPSRH group and one hundred and sixty-seven patients in CRH group completed the telephone interview about the long-term bladder function. The incidence of long-term urinary frequency [14.1% (12/85) vs 33.5% (56/167)], urinary incontinence [36.5% (31/85) vs 54.5% (91/167) ], urinary retention [23.5% (20/85) vs 38.9% (65/167) ] and straining to void [10.6% (9/85) vs 40.7% (68/167)], there were significantly lower in NPSRH group than those in CRH group ( all P < 0.05). The rate of recurrence was 10.8% (11/102) in NPSRH group and 12.2% (25/204) in CRH group (P = 0.707). Three-year recurrence-free survival (RFS) estimate was 88.5% in NPSRH group and 91.1% in CRH group (P = 0.746). Three-year overall survival (OS) estimate was 93.7% in NPSRH group and 96.3% in CRH group (P = 0.701). The univariate analysis shown that pathological type, lymph node metastases, and lymph-vascular space invasion (LVSI) presented the trend for a worst 3-year RFS and OS (P < 0.05) . The multivariate analyses shown that both pathological type and lymph node metastases were associated with a worst 3-year RFS (P < 0.05) . Lymph node metastases was a significant independent predictor of 3-year OS (P = 0.001) . NPSRH was not a significant independent predictor by Cox regression model analyses.
CONCLUSION
NPSRH contributes to bladder function recovery without compromising survival.
目的
比较保留神经平面的根治性子宫切除术（NPSRH）与传统根治性子宫切除术（CRH）术后膀胱功能及预后情况。
方法
2008年1月至2013年3月，102例国际妇产科联盟（FIGO）分期为Ib1-IIa2期的宫颈癌患者接受了开放性NPSRH（研究组）治疗。同期，随机选取204例行开放性CRH的患者作为对照组。两组患者年龄、病理类型及FIGO分期相匹配。
结果
NPSRH组和CRH组的中位手术时间分别为268.8分钟和242.4分钟（P<0.01）。中位住院时间分别为14.6天和17.2天（P<0.01）。两组的中位失血量分别为394ml和450ml（P>0.05）。输血率分别为46.1%（47/102）和41.7%（85/204；P>0.05）。术后并发症发生率无显著差异[14.7%（15/102）对11.8%（24/204），P>0.05]。两组间导尿的中位持续时间分别为9.1天和15.2天（P<0.01）。NPSRH组85例患者和CRH组167例患者完成了关于长期膀胱功能的电话随访。长期尿频发生率[14.1%（12/85）对33.5%（56/167）]、尿失禁发生率[36.5%（31/85）对54.5%（91/167）]、尿潴留发生率[23.5%（20/85）对38.9%（65/167）]及排尿困难发生率[10.6%（9/85）对40.7%（68/167）]，NPSRH组均显著低于CRH组（均P<0.05）。NPSRH组复发率为10.8%（11/102），CRH组为12.2%（25/204）（P=0.707）。NPSRH组三年无复发生存率（RFS）估计值为88.5%，CRH组为91.1%（P=0.746）。NPSRH组三年总生存率（OS）估计值为93.7%，CRH组为96.3%（P=0.701）。单因素分析显示，病理类型、淋巴结转移及脉管间隙浸润（LVSI）提示三年RFS和OS预后较差（P<0.05）。多因素分析显示，病理类型和淋巴结转移均与三年RFS较差相关（P<0.05）。淋巴结转移是三年OS的显著独立预测因素（P=0.001）。Cox回归模型分析显示NPSRH不是显著的独立预测因素。
结论
NPSRH有助于膀胱功能恢复且不影响生存率。
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