| Background and ObjectiveRadical hysterectomy and pelvic lymphadenectomy is the classic operation for the treatment of early cervical cancer.However the traditional radical resection has a wide range and a large wound,which can easily lead to the damage of pelvic nerve,thus causing different degree of pelvic floor dysfunction.Among them,bladder dysfunction is the most significant,which seriously affects the postoperative quality of life.Therefore,in order to reduce the intraoprative damage of pelvic nerve,reduce the incidence of pelvic floor dysfunction,it is an urgent problem to seek a new surgical treatment for cervical cancer.To compare the effects of laparoscopic nerve-sparing radical hysterectomy(LNSRH)and conventional laparoscopic radical hysterectomy(LRH)for cervical cancer on postoperative recovery and complications of cervical cancer patients,and determine the effect of LNSRH on the functions of pelvic viscera.Materials and MethodsA total of 194 patients with stages ⅠB1-ⅡA2 cervical cancer from the Second Affiliated Hospital of Zhengzhou University from Jan.2016 to Feb.2017 were analyzed retrospectively,58 receiving LNSRH and 136 receiving LRH.The general information such as age,body mass index,FIGO clinical stage,whethe or not to accept new adjuvant chemotherapy,and surgical indicators such as operation duration,blood loss,and complications of patients were collected and compared between the two groups.The postoperative functions of bladder and rectum,and their quality of life were assessed.Results1.All the operations were performed laparoscopically.No significant differences(P>0.05)were observed in the age,body mass index,maximum diameter of tumor,FIGO clinical stage,whethe or not to accept new adjuvant chemotherapy,and postoperative adjuvant therapy,etc.The operation duration of LNSRH group(325.00±22.63min)was longer than LRH group(296.96±51.65min),while the blood loss in LNSRH group(157.93±54.89ml)was less than LRH group(219.85±125.06ml).And they had statistically significant differences as both P<0.01.The other indicators including number of lymph nodes retrieved,length of resected vagina and paracervical tissues,had not significant differences.2.The median duration of postoperative catheterization in LNSRH group was much shorter than that in LRH group,and there was significant difference(10 d vs 21 d,P<0.001).The incidence rates of long-term(6 months after operation)urinary frequency,urinary incontinence and straining to viod in LNSRH group were significantly lower than those in LRH group,and all the differences were statistically significant(15.5% vs 35.3%,P<0.05;1.7% vs 10.3%,P<0.05;20.7% vs 53.7%,P<0.05).The duration of anal exhaust and defecation were shorter in LNSRH group than the other group(P<0.05).The constipation rates and tenesmus rates of two groups were 10.3%(6/58)and 19.9%(27/136),6.9%(4/58)and 21.3%(29/136),respectively.And there were significant differences among those two rates between two groups(P<0.05).The low sexual desire rates,decreased vaginal lubrication rates,sexual arousal dysfunction rates and sexual orgasmic dysfunction rates of two groups were 26.3%(10/38)and 46.8%(37/79),55.3%(21/38)and 83.5%(66/79),31.6%(12/38)and 51.9%(41/79),18.4%(7/38)and 38.0%(30/79),respectively.And there were significant differences among those four rates between two groups(P<0.05).3.Postoperative complications included infections,lymphatic cyst,poor wound healing,and so on.And all the differences in rates of postoperative complications were not statistically significant.The LNSRH group also had better postoperative scores of the Incontinence Quality of Life Questionnaire(IQOL)and the Pelvic Floor Impact Questionnaire 7(PFIQ-7)when compared with the LRH group(P<0.05).Conclusion1.It is safe and feasible to use the laparoscopic equipment to implement nerve-sparing radical hysterectomy.2.The operation duration of LNSRH group was longer than LRH group.But laparoscopic nerve-sparing radical hysterectomy can reduce the incidence rates of postoperative complications,also help restore bladder and rectum functions of patients with cervical cancer,greatly reduced the incidence of pelvic floor dysfunction and significantly improve the quality of life.3.LNSRH is a more ideal surgical method for the treatment of early cervical cancer and should be widely used in clinical practice. |
