The Correlation Between Laparoscopically Reserved Total Pelvic Autonomic Nerve Resection And Postoperative Bladder Function Recovery

Objective: To investigate the correlation between laparoscopic nerve sparing radical hysterectomy(LNSRH)and postoperative bladder function recovery and the feasibility of the operation.Methods: Sixty-six patients with cervical cancer(I Bl-IIA1 phase)who were treated surgically at the Affiliated Hospital of Qingdao University were divided into two groups according to the surgical method.The study group(30 cases)and the control group(36 cases)performed laparoscopic surgery.Underwent extensive laparoscopic nerve sparing radical hysterectomy(LNSRH).The control group underwent conventional laparoscopic nerve hysterectomy(LRH),hereinafter referred to as LNSRH group and LRH group.The general clinical features,surgical parameters(including operative time,intraoperative blood loss,intraoperative excision of the main sacral ligament,length of the anterior and posterior vaginal wall,number of lymph nodes,pathological findings),and postoperative bladder function recovery index for the two groups of patients,Including the number of successful removal of urinary catheters,residual urine volume,urine sensation and abdominal pressure urination,and follow-up in the first month,March,June,September,December,and 18 months after operation.Patient’s urination.All clinical data were statistically analyzed.Results: 1.There was no statistically significant difference in clinical data such as age,BMI,clinical stage,and pathological results between the two groups(P>0.05).2.The operative time of the study group and the control group were(254.33±26.68)min and(216.11±23.83)min,respectively;the difference was statistically significant(P<0.01);the intraoperative blood loss was(74.50±22.68)ml and 73.00±18.41)ml,the difference was not statistically significant(P>0.05)3.Both groups of patients were tested on the 7th day after operation and the residual urine volume was measured after two urinations.The average residual urine volume in the LNSRH group was 80.46 ml,which was significantly lower than that in the LRH group(122.61ml).),the difference was statistically significant(P<0.05).In the LNSRH group,residual urine volume was less than 100 ml in 20 patients and the urinary catheter was successfully removed(20/30,66.7%).Residual urine volume was <50ml(11/20,55%)in 11 patients;the LRH group had only In 10 patients,the catheter could be successfully removed(10/36,27.8%),and 3 of them had residual urine volume <50 ml(3/10,30%).There was a significant difference between the two groups(P< 0.05).4.All patients were withdrawn during the follow-up period.The length of catheter extraction in the LNSRH group was(9.30±2.47)days,which was significantly earlier than that of the LRH group(15.67±4.58)days.The difference was statistically significant(P< 0.05).5.In the two groups of patients,postoperative radiotherapy and chemotherapy with high postoperative factors were not included in follow-up.Among them,27 patients were in LNSRH group and 31 patients in LRH group were followed up.A total of 11 patients in the LNSRH group had a loss of urine sensation with a prevalence of 40.74%,and 21 patients in the LRH group had urinary tract loss,with an incidence of 67.74%.There was a significant difference between the two groups(P<0.05).The average days of urine sensation recovery time in the two groups were 60.36±7.78 days and 120.83±30.69 days,with a significant difference(P<0.05).At the end of follow-up,1 patient in the LNSRH group still did not recover urine sensation,while 9 patients in the LRH group still had urine loss.There was a statistically significant difference between the two groups.6.All patients were evaluated for abdominal pressure urination after the catheter was successfully withdrawn.Twenty-six patients in the LNSRH group had abdominal pressure voiding(12/27,44.44%),and 31 patients in the LRH group had 20 Abdominal pressure urination occurred in 64.51% of cases,and there was a significant difference between the two groups(P<0.05).The recovery time of abdominal pressure voiding in the LNSRH group and the LRH group was(90.36±10.91)and(180.83±20.74),respectively.At the end of the follow-up,there were still 2 patients requiring LBPH for abdominal voiding,and 10 patients in the LRH group required abdominal pressure for urination.There was a statistically significant difference between the two groups(P<0.05).Conclusion: The postoperative urination function and postoperative recovery of bladder function in patients with LNRH are better than those in LRH group.The retention of pelvic nerves is correlated with postoperative urination.LNRH is a viable surgical approach,to solve the urinary dysfunction in patients with a certain effect,improve the quality of life of patients after surgery.