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目的观察腹腔镜下行根治性子宫切除术中系统保留盆腔自主神经的临床效果。方法将26例宫颈癌患者在腹腔镜下实施保留盆腔自主神经广泛性子宫切除术,与同期21例行传统腹腔镜下广泛性子宫切除术患者比较,观察术中的出血量、手术时间及术后膀胱、直肠及性功能恢复情况等指标。术后定期随访,了解膀胱功能障碍、直肠功能障碍和性功能障碍发生情况。结果观察组患者的膀胱功能障碍、直肠功能障碍及性功能障碍的发生率均低于对照组(均P<0.05)。47例患者均顺利完成手术,观察组在手术时间、术后肠道恢复时间、切除盆腔淋巴结的数目、宫旁和阴道切除的范围和对照组比较,差异无统计学意义(P>0.05),术中出血量、术后住院时间明显少于对照组(P<0.05)。观察组平均留置尿管时间为(8.60±2.31)天,对照组为(18.47±3.59)天,两组比较,差异有统计学意义(P<0.05)。观察组直肠功能障碍发生率为19.2%,对照组为76.2%,两组比较,差异有统计学意义(P<0.05)。观察组性功能障碍发生率为11.50%,对照组为57.10%,两组比较,差异有统计学意义(P<0.05)。结论腹腔镜下保留盆腔的广泛性子宫切除术在技术上安全、可行,可明显减少术后膀胱、直肠及性功能障碍,既能保证疗效,又有利于患者术后的恢复及保证生活质量。
Objective To observe the clinical effect of preserving pelvic autonomic nervous system in laparoscopic radical hysterectomy. Methods Totally 26 patients with cervical cancer underwent laparoscopic radical hysterectomy for preserving pelvic autonomic nerve. Compared with 21 patients who underwent traditional laparoscopic radical hysterectomy, the amount of bleeding during operation, operation time and technique After the bladder, rectum and sexual function recovery and other indicators. Regular follow-up after surgery to understand the bladder dysfunction, rectal dysfunction and sexual dysfunction. Results The incidences of bladder dysfunction, rectal dysfunction and sexual dysfunction in observation group were lower than those in control group (all P <0.05). All the 47 patients completed the operation successfully. There was no significant difference in the operation time, the time of postoperative intestinal recovery, the number of pelvic lymph node resection, the range of uterine paralysis and vaginal resection in the observation group and the control group (P> 0.05) The amount of bleeding and postoperative hospital stay were significantly less than those of the control group (P <0.05). The mean duration of indwelling catheter in the observation group was (8.60 ± 2.31) days, while that in the control group was (18.47 ± 3.59) days. There was significant difference between the two groups (P <0.05). The incidence of rectal dysfunction in the observation group was 19.2%, while that in the control group was 76.2%. There was significant difference between the two groups (P <0.05). The incidence of dysfunction in observation group was 11.50% in control group and 57.10% in control group, the difference was statistically significant (P <0.05). Conclusions Laparoscopic extensive pelvic hysterectomy is technically safe and feasible. It can significantly reduce postoperative bladder, rectum and sexual dysfunction, which can not only ensure the curative effect, but also help patients to recover after operation and ensure the quality of life.