腹腔镜下保留与非保留盆腔神经广泛子宫切除术治疗宫颈癌的临床比较
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摘要
目的比较腹腔镜下保留与非保留盆腔神经广泛子宫切除术联合盆腔淋巴结清扫术治疗宫颈癌的效果及对患者膀胱直肠功能的影响。方法选取四川大学华西广安医院收治的140例宫颈癌患者,按术中是否保留盆腔神经将患者分为保留组(腹腔镜保留盆腔神经广泛子宫切除术+盆腔淋巴结清扫,n=64)与非保留组(广泛子宫切除术+盆腔淋巴结清扫,n=76),比较2组手术情况、术后恢复状况及膀胱直肠功能恢复情况,2组均于术前、术后3个月行尿动力学检查,测定膀胱顺应性、最大尿流率、最大膀胱容量、最大逼尿肌收缩压,统计2组术后并发症发生情况,均完成1年随访调查,采用宫颈癌生活质量评价表(FACT-Cx)评定患者生活质量的改善情况。结果 2组手术时间、术中出血量、淋巴结清扫数目、宫旁切除长度、阴道切除长度对比差异无统计学意义(P>0.05);保留组术后肛门排气时间、留置尿管时间、住院时间均短于非保留组(P<0.05);保留组各泌尿系统症状及并发症发生率均略低于非保留组,但仅尿失禁、尿潴留比较差异有统计学意义(P<0.05);术后,2组膀胱顺应性、最大尿流率、最大逼尿肌收缩压较治疗前均降低,最大膀胱容量较治疗前升高(P<0.05),但保留组术后膀胱顺应性、最大尿流率、最大逼尿肌收缩压均高于非保留组(P<0.05),且其术后不同生活质量评分均高于非保留组(P<0.05)。结论腹腔镜保留盆腔神经广泛子宫切除术联合盆腔淋巴结清扫术治疗宫颈癌可保护患者膀胱及直肠功能,提升患者术后生活质量,且根治效果肯定。
Objective To analyze the therapeutic effect of laparoscopic pelvic nerve-sparing and non-pelvic nervesparing radical hysterectomy in the treatment of cervical cancer and the in?uence on vesicorectal function. Methods The clinical data of 140 patients with cervical cancer treated in our hospital was collected. According to the intraoperative treatment of pelvic nerves, the patients were divided into the retention group(treated by laparoscopic pelvic nerve-sparing radical hysterectomy and pelvic lymphadenectomy, n=64) and non-retention group(treated by radical hysterectomy and pelvic lymphadenectomy,n=76). What happened during operation, postoperative recovery and recovery of bladder and rectal function were compared between the two groups. Urodynamic test was performed in the two groups before operation and 3 months after operation.Bladder compliance, the maximum urine f low rate, maximum bladder capacity and maximum detrusor systolic pressure were measured. The incidence of postoperative complications was statistically analyzed. All the patients were followed up for a year, and the improvement of quality of life(QOL) was evaluated with the Functional Assessment of Cancer Therapy-Cervix(FACT-Cx). Results There was no significant difference between the two groups in the duration of surgery, intraoperative blood loss, number of dissected lymph nodes, length of parametrial resection or the length of vaginal resection(P>0.05). The postoperative anal exhaust time, duration of indwelling catheters and hospital stay of the retention group were shorter than those of the non-retention group(P<0.05). The incidence of urinary symptoms and complications was significantly lower in the retention group than in the non-retention group(P<0.05). After operation,bladder compliance, the maximum urine f low rate and maximum detrusor systolic pressure were decreased while the maximum bladder capacity was increased in both groups(P<0.05). After operation, the bladder compliance, the maximum urine f low rate and maximum detrusor systolic pressure in the retention group were higher than those in the non-retention group(P<0.05), and the scores of quality of life were higher than those in the non-retention group(P<0.05). Conclusion The application of laparoscopic pelvic nerve-sparing radical hysterectomy combined with pelvic lymphadenectomy in the treatment of cervical cancer can protect the vesicorectal function in patients and improve their quality of life.
Objective To analyze the therapeutic effect of laparoscopic pelvic nerve-sparing and non-pelvic nervesparing radical hysterectomy in the treatment of cervical cancer and the in?uence on vesicorectal function. Methods The clinical data of 140 patients with cervical cancer treated in our hospital was collected. According to the intraoperative treatment of pelvic nerves, the patients were divided into the retention group(treated by laparoscopic pelvic nerve-sparing radical hysterectomy and pelvic lymphadenectomy, n=64) and non-retention group(treated by radical hysterectomy and pelvic lymphadenectomy,n=76). What happened during operation, postoperative recovery and recovery of bladder and rectal function were compared between the two groups. Urodynamic test was performed in the two groups before operation and 3 months after operation.Bladder compliance, the maximum urine f low rate, maximum bladder capacity and maximum detrusor systolic pressure were measured. The incidence of postoperative complications was statistically analyzed. All the patients were followed up for a year, and the improvement of quality of life(QOL) was evaluated with the Functional Assessment of Cancer Therapy-Cervix(FACT-Cx). Results There was no significant difference between the two groups in the duration of surgery, intraoperative blood loss, number of dissected lymph nodes, length of parametrial resection or the length of vaginal resection(P>0.05). The postoperative anal exhaust time, duration of indwelling catheters and hospital stay of the retention group were shorter than those of the non-retention group(P<0.05). The incidence of urinary symptoms and complications was significantly lower in the retention group than in the non-retention group(P<0.05). After operation,bladder compliance, the maximum urine f low rate and maximum detrusor systolic pressure were decreased while the maximum bladder capacity was increased in both groups(P<0.05). After operation, the bladder compliance, the maximum urine f low rate and maximum detrusor systolic pressure in the retention group were higher than those in the non-retention group(P<0.05), and the scores of quality of life were higher than those in the non-retention group(P<0.05). Conclusion The application of laparoscopic pelvic nerve-sparing radical hysterectomy combined with pelvic lymphadenectomy in the treatment of cervical cancer can protect the vesicorectal function in patients and improve their quality of life.
引文
[1]Kim HS,Kim TH,Suh DH,et al.Success Factors of Lapa roscopic Ner ve-sparing Radical Hysterectomy for Preserving Bladder Function in Patients with Cervical Cancer:A Protocol-Based Prospective Cohort Study[J].Ann Surg Oncol,2015,22(6):1 987-1 995.
[2]王小燕,朱慧芬,高贵花,等.保留盆腔神经对宫颈癌患者术后生存质量的影响[J].安徽医药,2016,20(6):1 154-1 155.
[3]陈瑶.腹腔镜下保留盆腔神经的根治性子宫切除术与传统广泛性全子宫切除术的疗效比较[J].大连医科大学学报,2015,37(1):49-52.
[4]廖利民.尿动力学技术规范--介绍国际尿控协会标准化报告[J].中国康复理论与实践,2005,11(11):875-878.
[5]Yan D,Yan H,Hallberg IR.Psychometric properties of the Chinese version of the Functional Assessment of Cancer Therapy-Cervix(FACT-Cx)measuring health-related quality of life[J].Health Qual Life Outcomes,2012,10(1):124.
[6]杨双祥.阴式子宫颈广泛切除术在治疗早期宫颈癌及保留生育功能中的作用[J].蚌埠医学院学报,2015,40(9):1 178-1 181.
[7]陈逸平,曹倩,徐克前,等.宫颈癌患者血清F OLR1、CA125和Hcy的测定及其意义[J].医学临床研究,2015,32(7):1 438-1 439.
[8]王文翔,高玉霞,段树锋,等.腹腔镜保留盆腔神经的广泛子宫切除对膀胱功能的影响[J].中华生物医学工程杂志,2016,22(5):415-418.
[9]王帅,黄浩.腹腔镜下保留盆腔神经的广泛子宫切除术现状分析[J].中国微创外科杂志,2012,12(12):1 139-1 140.
[10]Bogani G,Cromi A,Uccella S,et al.Nerve-sparing versus conventional laparoscopic radical hysterectomy:a minimum12 months'follow-up study[J].Int J Gynecol Cancer,2014,24(4):787-793.
[11]李斌,姚洪文,佐晶,等.腹腔镜在改良保留盆腔自主神经宫颈癌根治手术中的应用[J].中华肿瘤杂志,2014,36(1):63-68.
[12]王雁,赵虹.保妇康栓和聚甲酚磺醛栓治疗宫颈癌患者术后阴道上皮内瘤变的疗效比较[J].湖南师范大学学报(医学版),2016,13(2):28-30.
[13]庞辉,岳秀英.腹腔镜下保留盆腔自主神经的广泛子宫切除术对膀胱和直肠功能恢复的影响[J].中国妇幼保健,2017,32(14):3 384-3 386.
[14]周薇.腹腔镜下子宫广泛切除加盆腔淋巴结清扫术治疗早期宫颈癌的临床价值[J].中国基层医药,2012,19(21):3 307-3 308.
[15]夏欢,曹莉莉,蒋璐频,等.腹腔镜下保留盆腔自主神经的广泛性子宫切除术治疗早期宫颈癌的安全性及疗效的临床研究[J].实用妇产科杂志,2016,32(10):763-766.
[16]Choi CH,Lee JW,Lee YY,et al.Comparison of laparoscopicassisted radical vaginal hysterectomy and laparoscopic radical hysterectomy in the treatment of cervical cancer[J].Ann Surg Oncol,2013,130(1):3 839-3 848.
[2]王小燕,朱慧芬,高贵花,等.保留盆腔神经对宫颈癌患者术后生存质量的影响[J].安徽医药,2016,20(6):1 154-1 155.
[3]陈瑶.腹腔镜下保留盆腔神经的根治性子宫切除术与传统广泛性全子宫切除术的疗效比较[J].大连医科大学学报,2015,37(1):49-52.
[4]廖利民.尿动力学技术规范--介绍国际尿控协会标准化报告[J].中国康复理论与实践,2005,11(11):875-878.
[5]Yan D,Yan H,Hallberg IR.Psychometric properties of the Chinese version of the Functional Assessment of Cancer Therapy-Cervix(FACT-Cx)measuring health-related quality of life[J].Health Qual Life Outcomes,2012,10(1):124.
[6]杨双祥.阴式子宫颈广泛切除术在治疗早期宫颈癌及保留生育功能中的作用[J].蚌埠医学院学报,2015,40(9):1 178-1 181.
[7]陈逸平,曹倩,徐克前,等.宫颈癌患者血清F OLR1、CA125和Hcy的测定及其意义[J].医学临床研究,2015,32(7):1 438-1 439.
[8]王文翔,高玉霞,段树锋,等.腹腔镜保留盆腔神经的广泛子宫切除对膀胱功能的影响[J].中华生物医学工程杂志,2016,22(5):415-418.
[9]王帅,黄浩.腹腔镜下保留盆腔神经的广泛子宫切除术现状分析[J].中国微创外科杂志,2012,12(12):1 139-1 140.
[10]Bogani G,Cromi A,Uccella S,et al.Nerve-sparing versus conventional laparoscopic radical hysterectomy:a minimum12 months'follow-up study[J].Int J Gynecol Cancer,2014,24(4):787-793.
[11]李斌,姚洪文,佐晶,等.腹腔镜在改良保留盆腔自主神经宫颈癌根治手术中的应用[J].中华肿瘤杂志,2014,36(1):63-68.
[12]王雁,赵虹.保妇康栓和聚甲酚磺醛栓治疗宫颈癌患者术后阴道上皮内瘤变的疗效比较[J].湖南师范大学学报(医学版),2016,13(2):28-30.
[13]庞辉,岳秀英.腹腔镜下保留盆腔自主神经的广泛子宫切除术对膀胱和直肠功能恢复的影响[J].中国妇幼保健,2017,32(14):3 384-3 386.
[14]周薇.腹腔镜下子宫广泛切除加盆腔淋巴结清扫术治疗早期宫颈癌的临床价值[J].中国基层医药,2012,19(21):3 307-3 308.
[15]夏欢,曹莉莉,蒋璐频,等.腹腔镜下保留盆腔自主神经的广泛性子宫切除术治疗早期宫颈癌的安全性及疗效的临床研究[J].实用妇产科杂志,2016,32(10):763-766.
[16]Choi CH,Lee JW,Lee YY,et al.Comparison of laparoscopicassisted radical vaginal hysterectomy and laparoscopic radical hysterectomy in the treatment of cervical cancer[J].Ann Surg Oncol,2013,130(1):3 839-3 848.