The Effects Of Laparoscopic Bilateral Nerve-sparing Radical Hysterectomy On Bladder And Rectal Functions

Objective:To investigate the feasibility of laparoscopic bilateral nerve-sparing radical hysterectomy(LBNSRH)used for cervical cancer treatment and evaluate early recovery of bladder and rectal function postoperatively.Methods:From October 2015 to December 2017,100 cervical cancer patients with stage?bl to ?a1 admitted to the gynecology of the Zunyi Medical College Affiliated Hospital,among them,30 underwent LBNSRH,30 underwent laparoscopic unilateral nerve-sparing radical hysterectomy(LUNSRH)and 40 underwent laparoscopic radical hysterectomy(LRH).The data of operation time,amount of blood loss,the number of lymph nodes removed,the hospitalization time and postoperative complications were recorded in 3groups.The effects on bladder and rectal function for different operations were observed.Results:1.The operative time of the LBNSRH group and the LUNSRH group was significantly longer than that of the LRH group(all P<0.05).The operative time of the LBNSRH group was slightly longer than that of the LUNSRH group,but without statistical difference(P>0.05).There was no significant difference in the amount of surgical bleeding,the number of lymph nodes removed and the hospitalization time between the 3 groups(all P>0.05).All patients had no complications such as lymphocele,venous thrombosis,intestinal obstruction,and urinary leakage.2.The time of catheter removal in LBNSRH group was 11.60±3.64 d,which was significantly shorter than that of LUNSRH group(15.60±3.38d)and LRH group(26.13±5.68d),meanwhile,LUNSRH group was also shorter than LRH group,the difference was statistically significant(all P < 0.05).After removal of the urinary catheter,all patients in LBNSRH group and LUNSRH group had bladder filling sensation,which was higher than that of LRH group with 34 cases(85.00 %),but without statistical difference(all P>0.0167).Patients with LBNSRH and LUNSRH had spontaneous urination and complete urination were respectively 28 cases(93.33%)and 27 cases(90.00%),significantly higher than the LRH group(26 cases,65.00%),the difference was statistically significant(all P <0.0167).Patients with bladder function of level 0 in LBNSRH group and LUNSRH group were 53.33 %(16/30)and 46.67 %(14/30)of bladder function were significantly higher than those in the LRH group(15.00%,6/40)(all P<0.0167).There were no patients with bladder function of level?in LBNSRH group and LUNSRH group,and the proportion was significantly lower than that in the LRH group(17.50.00%,7/40)(all P<0.0167).The patients with bladder function at grade I were46.67%(14/30),53.33%(16/30),and 67.50%(27/40),with no statistical difference(all P>0.0167).3.The time of postoperative exhaust and defecation in LBNSRH group were 2.17±1.15 d and 3.31±1.33 d,respectively.The LUNSRH group was 3.30±1.86 d and 4.33±1.18 d,respectively,which were shorter than the LRH group with 4.53±1.66 d and 5.25±1.84 d,the difference was statistically significant(all P<0.05).Compared with the LUNSRH group,the degassing time and defecation time was significantly shorter in the LBNSRH group(P<0.05).Conclusion: 1.LBNSRH is safe and feasible in the treatment of early cervical cancer,although the operation time is longer than that of LUNSRH and LRH,but the amount of bleeding is not increased.2.Compared with LUNSRH,LBNSRH is more conducive to the early recovery of function of bladder and rectum after operation for patients.