The Studies Of Mata Analysis, Clinical Anatomy And Clinical Research In The Vaginal Radical Hysterectomy In Cervical Cancer

Transvaginal radical hysterectomy has a history of more than 100 years. Since Czermy founded transvaginal radical hysterectomy in 1879, after someone in the technology innovate ceaselessly. Since the progress of laparoscopic techniques, laparoscopic aortic lymph node dissection of success, and as the transvaginal radical surgery auxiliary parts used to treat cerical cancer. Based on minimally invasive, beautiful,postoperative recover faster than open surgery, more and more gynecologic oncologists will laparoscopic surgery and transvaginal the advantage of combination and discusses its safety and feasibility, transvaginal hysterectomy joint laparoscopic radical lymph node dissections have gradually presents huge application prospect.This research is divided into four parts:(1).Laparoscopically assisted radical vaginal hysterectomy versus abdominal radical hysterectomy for the treatment of early cervical cancer:A mata-analysis.(2).vaginal radical hysterectomy relevant application anatomic studies.(3).A comparison of laparascopic-assisted radical vaginal hysterectomy, total laparoscopic radical hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer.(4).The comparative study on stress response of laparoscopic-assisted radical vaginal hysterectomy,total laparoscopic radical hysterectomy and abdominal radical hysterectomy. Objective:To evaluate the clinical efect and safety of laparoscopic assisted radical vaginal hysterectomy.Methods:We searched the MEDLINE,EM -base,Cochrane Library,CBM,CNKI,Wan fang data,PubMed,Cochrane Library gynecologic oncologists,Professional database and evidence-based medicine database(to the end of the decade). Randomized controlled trials were identified according to the inclusion and exclusion criteria, then the quality of included trials was accessed, the data were extracted. mata-analysis was performed by RevMan4.2.2 soft ware.Results:conform to the criteria for the 10 articles,involv- ing 1010 participants were included,three of which for prospective randomized study,7 is retrospective case-control study.The literature fixed or random effects model mata analysis showed,and conventional abdominal radical hysterectomy radical group compared,Perioperative bleeding less WMD=312.75,95%CI(157.9 ,467.63),P<0.00001;low rate of blood transfusion OR=2.38, 95%CI(0.47,12.53), P=0.29;incidence rate of postoperative rate of postoperative complications low OR=3.89,95%C1(1.60,9.49),P=0.003;detaining urethral catheter short time WMD=4.99,95%C1(2.05,7.93),P=0.0009;postoertive hospitalization time short WMD=3.69,95%C1(2.47,4.91),P<0.00001.But the lack of evidence in postoper- ative rate OR=1.03,95%CI(0.54,1.46),P=0.94],operation time WMD=-36.64,95 %C1(-57.74,-15.55),P<0.001;lymph node dissection number WMD=-2.20,95% C1(-4.99,-9.39),P=0.55;Intraoperatie complications OR=0.53,95%C1(0.27,1.05 ),P=0.07;post-operative survival time,Lord,cases ligament excision, vaginal excision length is superior to open surgery.Conclusion:laparoscopic assisted radical vaginal hysterectomy is safe and feasible, can shorten the length of time,reduce intraoperatie blood loss, gastrointestinal function,bladder function recovery and postoperative complications advantages,but in intraoperatie complications,operation time,lymph node dissection number, postoperative survival time,recurrence rate,Cardinal ligament and Sacral ligament excision length,vaginal excision length compared with operation index and no obvious advantages. But included in the study less and the quality is not high quantity,demonstrates the intensity is weak,the necessary to design and develop large sample prospective randomized study to further verification.objective: by transvaginal retrograde autopsy understand female pelvic cavity structure, transvaginal hysterectomy for extensive application of anatomical basis provided. Methods: choose by 10% formalin fixed adult female pelvic cavity specimens,there were no 4 with pelvic surgeries. Application gross anatomical method on anatomy, with character, pictures and other forms records related results. Results: the anatomical can be informed, bladder cervical ligament is a pair of mixed connective tissue thickness, its contain many blood vessels, connected in the external wall and urethral cervix before after wall, bladder low wall and vagina front wall between. Observe the vagina and cervix adherent situation, thus the bladder is cervical ligament is divided into vaginal ministry and cervical part, surgery isolated and cut off the ligament when the ligaments observation carefully, thus avoiding damage variations within the ligament and above the ureteral uterine artery. Uterine cervix and uterus sacral ligament after both sides of the body by backward, both sides of the rectum sacral adherent to the surface, the surface coated with peritoneum forms, most of its patieats sacral uterus with 1~3 sacral vertebra connected with 4 sacral vertebra, connected to many. Conclusion: female pelvic structures carry out clinical surgery clinical anatomy is based, be helpful for the operation of develop smoothly.Objectives:To evaluate the feasibility,safety and complications prevention of laparoscopic-assisted radical vaginal hysterectomy(LARVH) with time-matched total laparoscopic radical hysterectomy(TLRH) and radical abdominal hysterectomy(RAH) in the treatment of cervical cancers.Methods: Thirty-two early-stage cervical cancer patients seen from April 2010 to April 2011 were randomized into LAVRH(8 patients),TLRH(10 patients)and ARH(14 patients)groups.The operative time,intraopemtivc blood loss,number of lymph nodes excised and complication rate were prospective analyzed.Results:Blood loss,blood transfusion rate,anus exhaust time, postoperative hospitalization days and retain urine tube time were significantly lower in the LAVRH and TLRH and TLRH group than ARH group(P<0.05),however,there were no signifcant differences between the LAVRH and TLRH groups(P>0.05).operation time were significantly higher in the LAVRH and TLRH group than ARH group(P<0.05). operation time were significantly higher in the TLRH group than LAVRH group(P<0.05).There were no signifcant differences for intraoperatie complications in three groups(P>0.05).Postoperative complications were significantly lower in the LAVRH and TLRH group than ARH group(P<0.05), however,there were no signifcant differences between the LAVRH and TLRH groups(P>0.05).There were no signifcant differences for excision length of Lord sacral ligament and vaginal and Lymph node dissection in three groups(P>0.05). The average follow-up of 6 months (1-10 months),One case occurred recurrence respectively.Conclusion:LAVRH is safe and feasible(recurrence and complications no difference,which has Minimally invasive, quick recovery, more economy etc, especially suitable for small tumors early cerical cancer.Objective:to compare the stress response of Laparoscopic-assiste radical vaginal hysterectomy,total laparoscopic radical hysterectomy and abdominal radical hysterectomy.Methods:Twenty-four early-stage cervical cancer patients seen from April 2010 to March 2011 were randomized into LAVRH(8 patients),TLRH(8 patients)and ARH(8 patients)groups.Stress response index (neutrophils,blood sugar,plasma levels of cortisol(COR),interleu- kin(IL-6),c-reactive protein(CRP))and body temperature were measured before and after surgery. Visual analogue scale (VAS) scores were also recorded after operation.Results:There are no significant difference in the changes of body temperature on the preoperative,third and fifth postoperative day compare of LAVRH,TLRH and ARH,the changes of body temperature were significantly lower in the LAVRH and TLRH group than ARH group on the first postoperative days(P<0.05),however,there were no signifcant differences between the LAVRH and TLRH groups(P>0.05).The changes of VAS were significant were significantly lower in the LAVRH and TLRH group than ARH group on the first,third and fifth postoperative days(P<0.05),there were no signifcant differences between the LAVRH and TLRH groups(P>0.05).The changes of neutrophils and COR were significantly lower in the LAVRH and TLRH group than ARH group on the first postoperative days(P<0.05),there were no signifcant differences between the LAVRH and TLRH groups(P>0.05).The changes of blood sugar were no significantly differences in the LAVRH,TLRH and ARH group(P<0.05).The changes of IL-6P were significantly lower in the LAVRH group than ARH group on the first,third postoperative days(P<0.05). The changes of IL-6P were significantly lower in the TLRH group than ARH group on the first postoperative days(P<0.05),there were no signifcant differences between the LAVRH and TLRH groups(P>0.05).The changes of CRP were significantly lower in the LAVRH group than ARH group on the first,third and fifth postoperative days(P<0.05).The changes of CRP were significantly lower in the TLRH group than ARH group on the first and third postoperative days(P<0.05),there were no signifcant differences between the LAVRH and TLRH groups(P>0.05).Conclusion:These findings suggest that there is less systemic stress response after LAVRH and TLRH than after ARH for cervical carcinoma patients;which show the superiority of minimally;especia- lly LAVRH the best.