腹腔镜下保留盆腔自主神经广泛性子宫切除术治疗早期宫颈癌患者的疗效研究

Effects of laparoscopic nerve-sparing radical hysterectomy on vesicorectal function in patients with early-stage cervical cancer

摘要:

目的 探讨腹腔镜下保留盆腔自主神经广泛性子宫切除术对肿瘤较小的早期宫颈癌患者术后膀胱、直肠功能的影响。方法 选取华东师范大学附属芜湖医院和皖南医学院第一附属医院妇科于2014年1月—2021年9月收治的肿瘤直径≤ 2 cm早期宫颈癌患者80例，采用随机数字表法分为两组。其中，40例行腹腔镜下保留盆腔自主神经广泛性子宫切除术为研究组，另40例行腹腔镜下常规广泛子宫切除术为对照组。比较两组患者的手术情况、术后膀胱功能、直肠功能恢复情况，以及术前、术后12个月的尿流动力学情况。绘制Kaplan-Meier曲线，比较生存率。结果 研究组手术时间长于对照组（P <0.05）；两组患者的术中出血量、清扫淋巴结数量、阴道切除长度、宫旁组织切除长度比较，差异无统计学意义（P >0.05）。研究组术后保留导尿时间短于对照组（P <0.05），研究组术后6个月排尿困难、腹压排尿、尿不尽占比小于对照组（P <0.05）；研究组术后首次肛门排气时间、自主排便时间均短于对照组（P <0.05），术后6个月便秘占比小于对照组（P <0.05）。两组患者手术前和术后12个月最大尿流率（MFR）、平均尿流率（AFR）、初始尿意膀胱容量、最大尿意膀胱容量、最大膀胱逼尿肌收缩力（MDP）差值比较，差异有统计学意义（P <0.05），研究组低于对照组。两组患者术后生存率比较，差异无统计学意义（P >0.05）。结论 腹腔镜下保留盆腔自主神经的宫颈癌手术对肿瘤较小的早期宫颈癌患者有着良好疗效，可改善患者术后膀胱直肠功能，恢复快，对生存结局无不良影响。

Abstract:

Objective To investigate the effect of laparoscopic nerve-sparing radical hysterectomy (LNSRH) on vesicorectal function in patients with early cervical cancer with small tumor.Methods Eighty patients with early cervical cancer whose tumor diameter ≤ 2 cm were admitted to Wuhu Hospital affiliated to East China Normal University and The First Affiliated Hospital of Wannan Medical College from January 2014 to September 2021 were divided into two groups by random number table method, 40 of whom underwent laparoscopic nerve-sparing radical hysterectomy (LNSRH) as the study group, and the other underwent conventional laparoscopic radical hysterectomy (LRH) as the observation group. The preoperative general information, postoperative bladder function and rectal function recovery, and preoperative and postoperative urodynamics of the two groups were compared.Results There were no significant differences in the amount of surgical bleeding, the number of dissected lymph nodes, the length of vaginal resection, and the length of parastatal tissue resection between the two groups (P > 0.05). The operation time of LNSRH group was longer than that of LRH group (P < 0.05). The retention catheterization time, anal exhaust time, and spontaneous defecation time were statistically significant between the two groups (P < 0.05), and the LNSRH group was shorter than the LRH group (P < 0.05). Six months after operation, the proportion of patients with dyuria, abdominal pressure, and constipation was significantly different between the two groups (P < 0.05), and the proportion of LNSRH group was lower than that of LRH group (P < 0.05). The results of urodynamics of the two groups were compared. The difference values of maximum urine flow rate (MFR), average urine flow rate (AFR), initial urinary bladder volume, maximum urinary bladder volume, and maximum detrusor contractile pressure (MDP) between the two groups before and 12 months after surgery were statistically significant (P < 0.05), and the differences of LNSRH group were smaller than those of LRH group. There was no significant difference in postoperative survival rate between the two groups (P > 0.05).Conclusion Laparoscopic radical pelvic autonomic nerve sparing hysterectomy has a good effect on patients with early cervical cancer with small tumor. It can improve the vesicorectal function of patients after operation, with fast recovery and no adverse impact on survival outcome.