腹腔镜下保留神经平面广泛子宫切除术对宫颈癌患者直肠和膀胱功能恢复的影响
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摘要
目的探讨腹腔镜下保留神经平面广泛子宫切除术对宫颈癌患者直肠和膀胱功能恢复的影响。方法选取2016年4月—2018年1月收治的宫颈癌患者105例为研究对象,按手术方法将其分为观察组60例和对照组45例,观察组实施腹腔镜下保留神经平面广泛子宫切除术,对照组实施腹腔镜下非保留神经平面广泛子宫切除术。对比2组手术指标、术后直肠和膀胱功能恢复以及并发症情况。结果 2组手术相关指标比较差异无统计学意义(P>0.05)。与对照组比较,观察组肛门排气时间、留置尿管时间、自主排便时间明显缩短,残余尿量更少,膀胱功能障碍发生率、并发症发生率更低,排尿满意度更高(P<0.05)。术后,2组的膀胱顺应性、最大尿流率、最大逼尿肌收缩压较术前均明显下降,最大膀胱容量较术前升高,观察组上述指标变化幅度小于对照组(P<0.05)。结论腹腔镜下保留神经平面广泛子宫切除术治疗宫颈癌可较好保留患者直肠和膀胱功能,且不影响手术疗效,不增加手术创伤,还能减少术后并发症。
Objective To investigate effects of laparoscopic nerve plane sparing radical hysterectomy on recovery of rectal and bladder function in treatment of patients with cervical cancer. Methods A total of 105 patients with cervical cancer admitted during April 2016 and January 2018 were divided into observation group(n=60) and control group(n=45) according to surgical methods. Observation group underwent laparoscopic nerve plane sparing radical hysterectomy, while control group underwent laparoscopic radical hysterectomy without nerve plane sparing. Operative indexes, functional recovery of rectum and bladder and incidence rate of complications after surgery were compared between two groups. Results There were no significant differences in surgical related indexes between two groups(P>0.05). Compared with those in control group, in observation group, anal exhaust time, indwelling catheter time and self-defecation time were significantly shortened; residual urine volume was less; incidence rates of bladder dysfunction and complications were lower, and urination satisfaction was better(P<0.05). After surgery, values of bladder compliance, maximum urinary flow rate and maximum systolic pressure of detrusor muscle were significantly decreased, and maximum bladder capacity was significantly increased compared with those before surgery in two groups; change ranges of the above indexes in observation group were less than those in control group(P<0.05). Conclusion laparoscopic nerve plane sparing radical hysterectomy on recovery of rectal and bladder function in treatment of patients with cervical cancer may well retain rectal and bladder functions and reduce incidence rate of postoperative complications without affecting surgical efficacy and increasing surgical trauma.
Objective To investigate effects of laparoscopic nerve plane sparing radical hysterectomy on recovery of rectal and bladder function in treatment of patients with cervical cancer. Methods A total of 105 patients with cervical cancer admitted during April 2016 and January 2018 were divided into observation group(n=60) and control group(n=45) according to surgical methods. Observation group underwent laparoscopic nerve plane sparing radical hysterectomy, while control group underwent laparoscopic radical hysterectomy without nerve plane sparing. Operative indexes, functional recovery of rectum and bladder and incidence rate of complications after surgery were compared between two groups. Results There were no significant differences in surgical related indexes between two groups(P>0.05). Compared with those in control group, in observation group, anal exhaust time, indwelling catheter time and self-defecation time were significantly shortened; residual urine volume was less; incidence rates of bladder dysfunction and complications were lower, and urination satisfaction was better(P<0.05). After surgery, values of bladder compliance, maximum urinary flow rate and maximum systolic pressure of detrusor muscle were significantly decreased, and maximum bladder capacity was significantly increased compared with those before surgery in two groups; change ranges of the above indexes in observation group were less than those in control group(P<0.05). Conclusion laparoscopic nerve plane sparing radical hysterectomy on recovery of rectal and bladder function in treatment of patients with cervical cancer may well retain rectal and bladder functions and reduce incidence rate of postoperative complications without affecting surgical efficacy and increasing surgical trauma.
引文
[1] Del Pino M,Svanholm-Barrie C,Torné A,et al.mRNA biomarker detection in liquid-based cytology:a new approach in the prevention of cervical cancer[J].Mod Pathol,2015,28(2):312-320.
[2] 刘恒,石冲.Furin和HPV联合检测在宫颈癌早期筛查中的应用[J].中国煤炭工业医学杂志,2017,20(9):1085-1088.
[3] 马莉萍.子宫切除术麻醉诱导前静脉泵注右美托咪定效果观察[J].临床误诊误治,2016,29(1):96-98.
[4] 李莉,杨晓清.腹腔镜下宫颈癌保留神经平面广泛子宫切除术的临床效果[J].中国计划生育学杂志,2016,24(8):548-551.
[5] 孔双,牛伟.广泛性子宫切除术联合盆腔淋巴结清扫术对宫颈癌患者盆底功能的影响[J].癌症进展,2018,16(3):379-381.
[6] Laterza R M,Sievert K D,de Ridder D,et al.Bladder function after radical hysterectomy for cervical cancer[J].Neurourol Urodyn,2015,34(4):309-315.
[7] 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.
[8] 陈丹,朱琴,李明明.宫颈癌患者腹腔镜广泛子宫切除术中盆腔自主神经功能保留对患者性功能的影响分析[J].中国性科学,2017,26(11):40-42.
[9] 郭维纳,路思思,汪宏波,等.腹腔镜下保留一侧盆腔自主神经广泛性子宫切除术治疗早期宫颈癌对膀胱功能的影响[J].神经损伤与功能重建,2016,11(4):327-329.
[10] 王倩青,纪妹.保留盆腔自主神经平面的广泛性子宫切除术对直肠功能的应用研究[J].中国妇幼保健,2016,31(8):1619-1622.
[11] 贺传勇,吴小莉,解为全,等.腹腔镜保留盆腔神经的广泛子宫切除术联合盆腔淋巴结清扫术治疗宫颈癌的疗效及对患者膀胱直肠功能的影响[J].河北医学,2018,24(6):951-955.
[12] Tsunoda A T,Andrade C E,Vieira M A,et al.Laparoscopy in uterine cervical cancer.Current state and literature review[J].Rev Col Bras Cir,2015,42(5):345-351.
[13] 张绒绒,娄文婧.宫颈癌术后排尿困难患者针灸治疗效果[J].中华保健医学杂志,2019,21(1):63-65.
[14] Shi R,Wei W,Jiang P.Laparoscopic nerve-sparing radical hysterectomy for cervicalcarcinoma:emphasis on nerve content in removed cardinal ligaments[J].Int J Gynecol Cancer,2016,26(1):192-198.
[15] 周文龙.腹腔镜下完成宫颈癌保留神经平面广泛子宫切除术的可行性分析[J].中国医药导报,2015,12(2):46-49,53.
[16] 杜克容,张彦.腹腔镜下保留神经平面广泛子宫切除术对宫颈癌患者术后血清AGR2、CTGF水平变化及不良反应的影响[J].中国临床医生杂志,2018,46(11):1347-1350.
[17] Aoun F,van Velthoven R.Lower urinary tract dysfunction after nerve-sparing radical hysterectomy[J].Int Urogynecol J,2015,26(7):947-957.
[18] Hunter J L.The impact of cervical cancer treatment on sexual function and intimate relationships:is anyone listening[J].Open J Obste Gyne,2014,4(8):479-490.
[2] 刘恒,石冲.Furin和HPV联合检测在宫颈癌早期筛查中的应用[J].中国煤炭工业医学杂志,2017,20(9):1085-1088.
[3] 马莉萍.子宫切除术麻醉诱导前静脉泵注右美托咪定效果观察[J].临床误诊误治,2016,29(1):96-98.
[4] 李莉,杨晓清.腹腔镜下宫颈癌保留神经平面广泛子宫切除术的临床效果[J].中国计划生育学杂志,2016,24(8):548-551.
[5] 孔双,牛伟.广泛性子宫切除术联合盆腔淋巴结清扫术对宫颈癌患者盆底功能的影响[J].癌症进展,2018,16(3):379-381.
[6] Laterza R M,Sievert K D,de Ridder D,et al.Bladder function after radical hysterectomy for cervical cancer[J].Neurourol Urodyn,2015,34(4):309-315.
[7] 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.
[8] 陈丹,朱琴,李明明.宫颈癌患者腹腔镜广泛子宫切除术中盆腔自主神经功能保留对患者性功能的影响分析[J].中国性科学,2017,26(11):40-42.
[9] 郭维纳,路思思,汪宏波,等.腹腔镜下保留一侧盆腔自主神经广泛性子宫切除术治疗早期宫颈癌对膀胱功能的影响[J].神经损伤与功能重建,2016,11(4):327-329.
[10] 王倩青,纪妹.保留盆腔自主神经平面的广泛性子宫切除术对直肠功能的应用研究[J].中国妇幼保健,2016,31(8):1619-1622.
[11] 贺传勇,吴小莉,解为全,等.腹腔镜保留盆腔神经的广泛子宫切除术联合盆腔淋巴结清扫术治疗宫颈癌的疗效及对患者膀胱直肠功能的影响[J].河北医学,2018,24(6):951-955.
[12] Tsunoda A T,Andrade C E,Vieira M A,et al.Laparoscopy in uterine cervical cancer.Current state and literature review[J].Rev Col Bras Cir,2015,42(5):345-351.
[13] 张绒绒,娄文婧.宫颈癌术后排尿困难患者针灸治疗效果[J].中华保健医学杂志,2019,21(1):63-65.
[14] Shi R,Wei W,Jiang P.Laparoscopic nerve-sparing radical hysterectomy for cervicalcarcinoma:emphasis on nerve content in removed cardinal ligaments[J].Int J Gynecol Cancer,2016,26(1):192-198.
[15] 周文龙.腹腔镜下完成宫颈癌保留神经平面广泛子宫切除术的可行性分析[J].中国医药导报,2015,12(2):46-49,53.
[16] 杜克容,张彦.腹腔镜下保留神经平面广泛子宫切除术对宫颈癌患者术后血清AGR2、CTGF水平变化及不良反应的影响[J].中国临床医生杂志,2018,46(11):1347-1350.
[17] Aoun F,van Velthoven R.Lower urinary tract dysfunction after nerve-sparing radical hysterectomy[J].Int Urogynecol J,2015,26(7):947-957.
[18] Hunter J L.The impact of cervical cancer treatment on sexual function and intimate relationships:is anyone listening[J].Open J Obste Gyne,2014,4(8):479-490.