Yamamoto Akihito, Kamoi Seiryu, Ikeda Mariko, Yamada Takashi, Yoneyama Koichi, Takeshita Toshiyuki
Department of Obstetrics and Gynecology, Nippon Medical School.
J Nippon Med Sch. 2021 Nov 17;88(5):386-397. doi: 10.1272/jnms.JNMS.2021_88-503. Epub 2020 Aug 1.
Radical hysterectomy (RH) is a type of radical surgery for cervical cancer. Urinary dysfunction due to RH worsens postoperative quality of life of patients with cervical cancer. Nerve-sparing RH (NSRH) technique has been used as an effective means to conserve urinary function. However, few reports have examine long-term outcomes after NSRH. This study describes the details and long-term outcomes of our nerve-sparing technique.
Sixty-one patients underwent radical hysterectomy in a 5-year period during which nerve-sparing technique was introduced; of these, 31 patients underwent NSRH and 30 underwent conventional RH. We retrospectively examined their medical records and compared postoperative urinary function and treatment outcomes between these two groups.
The median time required for urinary residual volume to fall to ≤50 mL after removal of the urinary catheter was 6 days (range, 2-20 days) in the NSRH group and 13.5 days (range, 3-46 days) in the RH group. The results were significantly better in the NSRH group (p < 0.05). The mean follow-up period was 2456.3 days (range, 48-4,213 days). Analysis of curability revealed no significant difference between the two groups in local recurrence or long-term survival rates. The 5-year survival rate was 0.861 in the NSRH group and 0.782 in the RH group; the 10-year survival rate was 0.861 in the NSRH group and 0.679 in the RH group.
NSRH significantly improved postoperative urinary function without worsening local recurrence rates or long-term outcomes.
根治性子宫切除术（RH）是宫颈癌的一种根治性手术。RH导致的排尿功能障碍会恶化宫颈癌患者的术后生活质量。保留神经的RH（NSRH）技术已被用作保留排尿功能的有效手段。然而，很少有报告研究NSRH后的长期结果。本研究描述了我们的保留神经技术的细节和长期结果。
在引入保留神经技术的5年期间，61例患者接受了根治性子宫切除术；其中，31例患者接受了NSRH，30例接受了传统RH。我们回顾性检查了他们的病历，并比较了两组患者术后的排尿功能和治疗结果。
NSRH组拔除导尿管后残余尿量降至≤50 mL所需的中位时间为6天（范围2 - 20天），RH组为13.5天（范围3 - 46天）。NSRH组的结果明显更好（p < 0.05）。平均随访期为2456.3天（范围48 - 4213天）。治愈率分析显示，两组在局部复发率或长期生存率方面无显著差异。NSRH组的5年生存率为0.861，RH组为0.782；NSRH组的10年生存率为0.861，RH组为0.679。
NSRH显著改善了术后排尿功能，且未使局部复发率或长期结果恶化。
