Nerve-sparing Radical Hysterectomy In Patients With Cervical Cancer.

Purpose:The aim of this study is to develop and modify our nerve-sparing radical hysterectomy(NSRH) technique and assess its efficacy as well as safety.Methods: Thirty-nine patients with FIGO stageâ… B1-â…¡A cervical cancer were enrolled in NSRH group(study group).Nerve-dissecting NSRH(NDNSRH) was performed in the previous 16 patient of NSRH group.The pelvic autonomic nerve pathway, including hypogastric nerve(HN),pelvic splanchnic nerve(PSN),inferior hypogastric plexus(IHP) and bladder branch(BB) was systematically dissected and preserved during the procedure.In the last 23 patients of NSRH group, mesoureter-preseving NSRH(MPNSRH) was developed.In the control group, conventional radical hysterectomy(CRH) was performed in 30 patients.Related parameters were compared between groups.Results:The clinical and pathologic characteristics were comparable between study and control group(P>0.05).There was no significant difference between the two groups regarding the age,body mass index,blood lost of patients(P>0.05),but the NSRH group had a significant longer duration of the surgery(P<0.01).More patients in NSRH group had post-void residual urine volume(PVR)<100ml than that in CRH group on the day 8 after surgery(61.5%vs.16.7%,P<0.01).The median duration of postoperative catheterization was significantly shorter in NRSH group(8-23 days,median 8days) than that in control group(8-32 days,median 20days)(P<0.01).Pelvic complications significantly affected postoperative bladder function.MPSRH achieved a significant shorter duration of the surgery,(P<0.01) but never achieved better bladder function as compared with NDNSRH.There was no significant difference between the NSRH and control groups regarding sexual dysfunction(69.2.% vs.70.0%,P>0.05).Colorectal disorder was rare in the study.In the NSRH group,no serve injury or morbidity was reported,even no pathologically positive margin was found.Conclusions:NSRH is a feasible and safe technique for preserving bladder function.MPNSRH is superior to NDNSRH.