Department of Gynaecology, University Hospital Leipzig, Leipzig, Germany.
Department of Urology, University Hospital Leipzig, Leipzig, Germany.
BJOG. 2020 Jun;127(7):859-865. doi: 10.1111/1471-0528.16167. Epub 2020 Mar 2.
To evaluate the feasibility and effect of mesureteral preservation on urinary complications in the context of total mesometrial resection (TMMR), a surgical treatment for cervical cancer.
Retrospective cohort study with historic control.
Single tertiary academic centre.
Women older than 18 with primary cervical cancer staged FIGO IB1-IIB enrolled in the prospective Leipzig School MMR study and underwent total mesometrial resection (TMMR) without adjuvant radiation.
We retrospectively analysed 100 consecutive TMMR procedures which were performed for cancer of the uterine cervix and in which the mesureter was preserved (intervention group, 01/2014-06/2017). We compared this group with the previous 100 consecutive TMMRs, which were performed before the introduction of mesureteral preservation (control group, 09/2010-01/2014).
The occurrence of urological and specifically ureteral complications.
Mesureteral preservation was feasible and was associated with a significant decrease in ureteral complications (11% without mesureteral preservation versus 3% with mesureteral preservation, P = 0.049). Furthermore, we found a significant decrease in the number of postoperative percutaneous nephrostomies and re-operations (7% versus none, P = 0.014). There was also a trend towards a decrease in other urinary complications such as postoperative bladder atony and uretero-vaginal fistulas.
The mesureter constitutes a convenient dissection plane enabling the preservation of lateral ureteral blood supply during TMMR. In our study, maintenance of mesureteral integrity was associated with a significant reduction in ureteral complications. Mesureteral preservation might also be useful in other types of pelvic surgeries that carry a high risk of ureteral damage.
Surgical preservation of the mesureter in cervical cancer patients was associated with a reduction in urinary complications.
评估在全子宫系膜切除术（TMMR）中保留子宫动脉对宫颈癌患者发生泌尿系统并发症的可行性和效果。
回顾性队列研究，设历史对照。
单中心三级学术医院。
年龄大于 18 岁，FIGO 分期 IB1-IIB 的宫颈癌患者，入组莱比锡子宫系膜切除术研究并接受 TMMR 治疗且未行辅助放疗。
我们回顾性分析了 100 例行 TMMR 治疗的宫颈癌患者的临床资料，其中 50 例行子宫动脉保留术（干预组，2014 年 1 月至 2017 年 6 月），另外 50 例行 TMMR 术但不保留子宫动脉（对照组，2010 年 9 月至 2014 年 1 月）。比较两组患者的临床资料和泌尿系统并发症发生情况。
泌尿系统并发症发生情况。
子宫动脉保留术安全可行，与对照组相比，术后输尿管并发症显著减少（11% vs. 3%，P=0.049），术后需要行经皮肾造瘘和再次手术的患者也显著减少（7% vs. 0，P=0.014）。同时，术后膀胱乏力和输尿管阴道瘘等其他泌尿系统并发症的发生率也呈下降趋势。
子宫动脉构成了一个便利的解剖平面，在 TMMR 中可保留输尿管的侧支血供。本研究中，子宫动脉的保留与输尿管并发症的显著减少相关。子宫动脉保留术可能对其他存在输尿管损伤高风险的盆腔手术也有益处。
保留子宫动脉对宫颈癌患者接受全子宫系膜切除术（TMMR）后的泌尿系统并发症有显著的降低作用。
