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目的:探讨腹腔镜保留神经的广泛子宫切除术治疗宫颈癌的可行性及临床价值。方法:自2008年3月~2009年8月郑州大学第三附属医院对17例Ⅰa~Ⅱa期宫颈癌患者行腹腔镜保留神经的广泛子宫切除术,同传统腹腔镜下非保留神经手术对比,分析两组手术时间、术中出血量、手术范围及术后患者膀胱、直肠功能恢复情况。结果:17例患者中2例因出血较多保留单侧神经,1例为Ⅱa期选择性保留病灶对侧盆腔神经,余成功保留双侧神经。保留组手术时间明显延长(P<0.05),排气时间、留置尿管时间显著缩短(P<0.05),术中出血量、切除宫旁组织宽度差异无统计学意义(P>0.05)。术后3个月随访,保留组患者膀胱、直肠功能明显优于非保留组。结论:腹腔镜保留神经的广泛子宫切除术治疗宫颈癌具有可行性,不影响手术范围,初步证明其有利于保护患者膀胱、直肠功能。
Objective: To investigate the feasibility and clinical value of laparoscopic radical hysterectomy for the treatment of cervical cancer. Methods: From March 2008 to August 2009, the Third Affiliated Hospital of Zhengzhou University performed laparoscopic radical hysterectomy on 17 patients with stage Ⅰa-Ⅱa cervical cancer. Compared with conventional laparoscopic non-conservative surgery, The operation time, intraoperative blood loss, the scope of surgery and postoperative recovery of bladder and rectum were analyzed. Results: In 17 patients, 2 patients retained unilateral nerves due to more bleeding and 1 patient retained selective contralateral pelvic nerves in Ⅱa. The operation time in the retention group was significantly longer (P <0.05), and the time of exhausting and indwelling catheter was significantly shorter (P <0.05). There was no significant difference in the amount of bleeding during operation and the excision of palatoplasty (P> 0.05). After 3 months of follow-up, the bladder and rectum of the patients in the retention group were significantly better than those in the non-retention group. Conclusions: Laparoscopic extensive hysterectomy for the treatment of cervical cancer is feasible, does not affect the scope of surgery, initially proved its beneficial to the protection of patients with bladder and rectal function.