The Clinical Study And System Evaluation Of The Safety And Efficacy Of LNSRH In The Treatment Of Early Cervical Cancer

Cervical cancer is one of the most common malignant tumors in women.It has high incidence and high mortality,threat to women's physical and mental health seriously.Classical radical hysterectomy(ARH)combined with pelvic lymph node dissection is the classic treatment for early stage cervical cancer,the 5 years survival rate can reach more than 80%.However,it has a wide range of resection,large trauma,long recovery time and poor quality of life.In recent decades,laparoscopic surgery has made rapid progress in the field of surgery,and applied to the field of gynecologic malignancies.It is found that laparoscopic radical hysterectomy(LRH)is superior to traditional ARH,and it's a new choice for the treatment of early stage cervical cancer.Both laparoscopic and open surgery,postoperative patients with pelvic autonomic nerve injury is associated with dysfunction,affecting the quality of life after surgery.In order to effectively alleviate the compli cations and protect the physiological function of the patients,the gynecologic surgeons explore the method of pelvic autonomic nerve preservation constantly.With the achievement of laparoscopy in gynecologic malignant tumor,it is found that the fine anatomy of the pelvic cavity can be realized by making full use of the advantages of laparoscopy.So it's more easy to retain pelvic autonomic nerve.As a result,the laparoscopic nerve-sparing radical hysterectomy(LNSRH)came into being.However,there are still many problems need to be solved in the surgical technique.In particular,the safety and clinical efficacy of LNSRH received the most attention of the majority of physicians.In order to evaluate the safety and efficacy of LNSRH,this study not only carried out clinical studies,but also made a systematic evaluation.The main research methods and results are as follows:1.The clinical study on the safety and efficacy of LNSRH in the treatment of early stage cervical cancerCervical cancer patients admitted to Southwest Hospital from 2008 to 2011 were selected as the research object.The clinical data of patients were collected and investigated follow-up.253 patients met the inclusion criteria,they were divided into LNSRH group(n=116)and LRH group(n=119).Compared the preoperative parameters,operation parameters,surgical resection range,operative complications,the evaluating indicator of postoperative recovery of bladder function,postoperative anal exhaust time,defecation time,etc.Recurrence free survival and survival time of the two groups were compared by survival analysis,and draw the survival curve.The results: 1.There was no significant difference between the two groups in preoperative parameters(P> 0.05).2.There was no significant difference between the two groups in terms of operation parameters,surgical resection and surgical complications(P > 0.05).3.Comparison of postoperative bladder function: In the LNSRH group,the average indwelling catheter time was 13.6± 6.1 days,significantly shorter than that in the LRH group(18.0± 6.9 days),and the difference was statistically significant(P < 0.05).A total of 157 patients can feel the bladder filling,LNSRH group of 82 cases,LRH group of 75 cases.And there was no significan t difference between the two groups(P > 0.05).The incidence of postoperative bladder dysfunction,the incidence of abdominal pressure and urinary retention were significantly lower in LNSRH group than in LRH group,and the difference was statistically si gnificant(P < 0.05).4.Comparison of postoperative rectal function: There was no significant difference between the two groups in postoperative recovery time and defecation time(P>0.05).5.Survival analysis: There was no significant difference in recurrence free survival time between the two groups,Log Rank test,P=0.802;The cumulative survival rate was 86.4% in LNSRH group,and LRH group was 89.1%,Log Rank test,P=0.663.There was no difference in survival time between the two groups.2.The system evaluation of the safety and efficacy of LNSRH in the treatment of early cervical cancerSearch the Pub Med,MEDLINE,CNKI and Wan Fang database,to select the clinical study of LNSRH in the treatment of early stage cervical cancer.Inclusion criteria were included in the clinical study,to made quality assessment and data extraction.Meta analysis can be used to the data that can be combined with RevMan5.3 software.On the contrary,descriptive analysis.The results: Finally,5 papers were included in the English literature,7 papers were included in the Chinese literature.A total of 931 patients,of which 479 cases were in the LNSRH group and the other 452 cases were in the laparoscopic radical hysterectomy(LRH)group.The results of System evaluation:1.There was no significant difference in the operation time and intraoperative blood loss between the two kinds of operation(P>0.05).2.There was no significant difference in the length of the two types of vaginal resection(P>0.05).3.The LNSRH parametrial tissue resection length was shorter than the LRH,and the number of lymph node was less than LRH,the difference was statistically significant(P<0.05).4.There was no significant difference in the postoperative complications and postoperative complications between the two types of operation(P>0.05.5.The recovery of bladder function and rectal function after LNSRH was better than that of LRH(P<0.05).6.There is no significant difference between the long-term prognosis of two operative methods.ConclusionLaparoscopic nerve-sparing radical hysterectomy in the treatment of early cervical cancer is safe and reliable,compared with laparoscopic radical hysterectomy,it has a significant protective effect on the bladder function.LNSRH does not reduce the survival rate of patients with early cervical cancer.