| Research Background and ObjectivesOver the past20years, laparoscopes have been accepted by more and more clinicians and applied to practical use in gynecological surgery. Laparoscopes have the following features:small celiac interference, small incisions, less blood loss, clear vision of surgery, shorter recovery time. Cervical cancer is one of the common gynecological tumors, and surgery, radiotherapy, chemotherapy is the primary means of treatment. With the younger age of onset and increased requirements on the quality of life by patients, traditional abdominal radical hysterectomy plus pelvic lymphadenectomy can not meet the requirements of patients because of the following reasons:relatively large surgical trauma, and more blood loss, slow recovery after operation, and the degree of operative field exposure is greatly influenced by the patient’s own conditions. Laparoscopes, because of its advantages, they are naturally favored by clinicians and patients in cervical cancer surgical treatment. Our hospital carries out laparoscopic radical hysterectomy, and at the same time, we explore the solutions to the following problems of the patients and others:obvious shortening of vagina after surgery, sexual difficulties, and endocrine change, and also conducts the laparoscopic ovarian autologgus with vascular displacement, and lengthening and peritoneal vaginoplasty. This study aims at:First:make a comparison of the clinical efficacy between laparoscope and abdominal radical hysterectomy plus pelvic lymphadenectomy in the treatment of early-stage. Second, observe the sexual life quality and changes of endocrine level of young cervical cancer patients before and after surgery when carry out the laparoscopic radical hysterectomy plus pelvic lymphadenectomy, at the same time the ovarian autologous with vascular displacement plus vaginal lengthening surgery.MethodsThe study group contains65cases of patients with early cervical cancer from the department of gynecology of the First Affiliated Hospital of Zhengzhou University accepted from March2008to October2012, aging from26to41years old, with an average of35.7years old. Preoperative case biopsy shows they have cervical cancer.According to the clinical staging standard of cervical cancer International of the Federation of Gynecology and Obstetrics FIGO, their staging will be:18cases of Ibl,26cases of Ib2, and21cases of Ⅱa, Then we conduct the laparoscopic radical hysterectomy plus pelvic lymphadenectomy, ovarian transposition and vaginal lengthening surgery.Take78cases of Ⅰb1-Ⅱa patients treated in the same period for the control group, aging from28to43years old, the average age being39.2. And there are27cases of Ibl,31cases of Ib2,20cases of Ⅱa. Then we conduct the abdominal radical hysterectomy plus pelvic lymphadenectomy, ovarian transposition and vaginal lengthening surgery. Age, vaginal length, weight, pathological grading, histological type and clinical staging, all these factors, by comparison, p>0.05, so the difference was not statistically significant.Results: 1. All the143surgeries were successfully completed, as for the surgery time and blood loss, the difference was statistically significant (p<0.05), and for the number of clearing lymph nodes, no significant difference.2. Results of laparoscopic group and abdominal surgery group:as for the urinary catheter retention time, postoperative complications, the difference was not statistically significant (p>0.05), and for the anal exhaust time, postoperative hospital stay time, there is a significant difference (p<0.05) between the two groups.3. Vaginal LengthDuring a period of six months preoperation and postoperation, the distance from the vagina mouth to posterior vaginal fornix or the vaginal stump are measured, preoperative vaginal length of the experimental group is:(10.22±2.47) cm, and6months postoperatively (8.58±1.75) cm. Compared with preoperation P>0.05.At the same time, preoperative vaginal length of the control group is (10.52±1.37) cm, and after6months (9.01±1.79) cm, and P>0.05compared with preoperation. Postoperative vaginal length of experimental and control group, when compared, p>0.05, so there is no statistical significance.Gynecological examination is carried out6months later between experimental and control group, there is no TCT smear abnormality, and there is good agreement between the vaginal stump and the bladder, rectum, uterus fold-back peritoneal. Extension of the vaginal mucosa is smooth, soft and elastic, the top has two-finger width, and defecation and urination are normal.4. Ovarian Hormone Level of3months after surgeryFollicule-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) are measured by radioimmunoassay before surgery, their levels were in the normal range. Values of FSH, LH and E2of the two groups were measured again3months after surgery, compared with preoperation, the difference was not statistically significant (p>0.05). Also, there is no case of menopausal symptom in the follow-up period.5. The Quality of Sexual LifeDuring the follow-up period, there are no tumor recurrence and patient death. Then the female sexual function scale is used to test the postoperative sexual desire of the experimental group and the control group. The results show that FSFI score of the experimental group was26.34±3.04, FSFI score of the control group was26.26±4.58, the difference of the experimental group and the control group was not statistically significant. According to the sexual function scale, the difference of those various indicators of the experimental group and the control group was not statistically significant. And the FSFI total score of the experimental group:more than26.55points:56cases; less than26.55points:eight cases; and one case has no sexual life. And the FSFI total score of the control group:more than26.55points:66cases; less than26.55points:10cases; and two cases have no sexual life.12.30%of the experimental group was sexual function decrement patients, and12.82%of the control group was sexual function decrement, so both showed no significant differences.Conclusion:1. Laparoscopic ovarian transposition plus vaginal extension and laparotomy ovarian transposition plus vaginal extension, all these actions reached the purposes of preserving ovarian function, maintaining hormone levels, and improving sexual quality of life.2. For the patients, the laparoscopic surgery has less trauma, and shorter recovery time, and has good efficacy for the treatment of early cervical cancer. |
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