| Research background:Cervical cancer is still represents a major health issue,being the second most common malignancy among women.With the advances in screening technologies,the early diagnosis rate was improved.Its incidence has showed increasing trend in recent years,and it has trended to be younger.Because of the improvement of surgical technic,the 5 year survival rate of earlier stage patients is as high as 80%-90%.So except for prolong the survival period,more work need to do for improving the quality of life.Radical hysterectomy with pelvic lymphadenectomy is a classic clinical surgical treatment for early cervical cancer.Conventional radical hysterectomy causes damage to the pelvic autonomic nerves,which is believed to lead to pelvic floor dysfunction.Such as bladder dysfunction(frequency,urgency,urinary incontinence,urinary retention,abdominal pressure urination),anorectal dysfunction(constipation,diarrhea and fecal incontinence),sexual dysfunction(decreased libido,sexual arousal disorder,orgasmic disorder,sexual satisfaction decline),seriously affecting the quality of life.In order to reduce the postoperative complications and improve the quality of life of patients,a nerve-sparing modification of the Wertheim operation has been routinely applied to radical hysterectomy for cervical cancer.With the development of the technology,the magnified view of laparoscopes has allowed a cl earer visualization of structures such as nervous branches,thus favoring the adoption of nerve-sparing techniques,during radical procedures.In 2008,nerve-sparing radical hysterectomy is included in the latest classification of cervical cancer surgery.Objective:To evaluate the pelvic floor function and quality of life of laparoscopic nerve-sparing radical hysterectomy(LNSRH)for cervical cancer compared with laparoscopic radical hysterectomy(LRH)Methods:A retrospective cohort pilot study was carried out to comparing the pelvic floor function of LNSRH(n=138,treatment group)with that of LRH(n=138,control group).All these patients underwent the surgeries in our department from January 2012 to December 2014.Results:All the patients were performed successfully.No significant differences were found in blood loss,mean operation time,numbers of pelvic lymph nodes resected,extent of vagina resection,mortality and recurrence rates between the two groups(P>0.05).The length of hospital stay were better in the LNSRH group(P<0.05).The bladder and anorectal function:The time of catheter removed were concentrated in 7~14 days at LNSRH group,while LRH group were >15 days.The recovery time of bowel,complications of urinary(34.8% and 71.0%)and digestive(21.7% and 49.3%)system were better in the LNSRH group.The postoperative scores of I-QOL and PFIQ-7 were significantly better in the LNSRH group than in the LRH group.Sexual function: the FSFI score after investigation was shown in table 4.There was no significant difference between the two groups before the surgery(P>0.05).The scores of sexual desire,subjective arousal,orgasm and sexual satisfaction were higher in LNSRH group than in LRH group after operation(P<0.05).There was no significant difference in vaginal lubrication and algopareunia(P>0.05).The total score of LNSRH group was higher than that in LRH group(P<0.01)The quality of life after surgery: two groups of SF-36 score were shown in Table 5.The total score of LNSRH group was higher than that in LRH group(P<0.05).The scores of the Physical(PCS)and Mental Component Summary scales(MCS)were higher in LNSRH group than in LRH group after operation(P<0.05).ConclusionNever-sparing laparoscopy radical hysterectomy is feasible in treatment of cervical cancer,which can protect postoperative pelvic floor function,and is helpful to improve the quality of life for patients. |
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