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腹腔镜下行保留神经的根治性子宫切除术加筋膜间隙分离术治疗宫颈癌:技术描述与手术结果
Laparoscopic nerve-sparing radical hysterectomy with fascia space dissection technique for cervical cancer: Description of technique and outcomes
Liang Z, Chen Y, Xu H, Li Y, Wang D  2010/11/4 17:45:00 
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Gynecologic Oncology, 2010, Volume 119, Issue 2 
 

Objectives: The objectives of this study were to describe our laparoscopic nerve-sparing radical hysterectomy (LNSRH) technique and to assess the feasibility and safety of the procedure, as well as its impact on voiding function. We introduce a fascia space dissection technique in order to preserve the pelvic splanchnic nerve, the hypogastric nerve and the bladder branch of the inferior hypogastric plexus under magnification (× 10.5) during laparoscopic radical hysterectomy (LRH) with pelvic lymphadenectomy. Methods: From October 2006 to November 2009, 163 consecutive patients with cervical cancer underwent laparoscopic radical hysterectomy (LRH) and pelvic lymphadenectomy, with 82 women undergoing LNSRH with fascia space dissection technique (LNSRH group) and 81 undergoing LRH (LRH group). Data from 163 patients were prospectively collected and compared. Post-operative assessment of bladder function included the following: the time to recover the ability to void spontaneously and to achieve a post-void residual urine (PVR) volume of less than 50 ml, with urination function graded. Results: The laparoscopic nerve-sparing radical hysterectomy procedure was completed successfully and was conducted safely in all of the patients. There were no conversions to open surgery in the two groups. The median operative duration in the LNSRH and the LRH groups were 163.52 ± 34.47 min and 132.13 ± 31.42 min, respectively. Blood loss was 142.12 ± 62.38 ml and 187.69 ± 68.63 ml, respectively. The time taken to obtain a post-void residual urine volume of less than 50 ml after removal of the urethral catheter was 7.42 ± 2.35 d (5-18 d) in LNSRH group and was 16.75 ± 7.73 d (5-35 d) in LRH group (P < 0.05). The bladder void function recovery to Grades 0-I was 76 (92.7%) for the LNSRH group and 59 (72.8%) for the LRH group. A mean follow-up of 22.3 (5-42) months was adhered to, and no patient had a recurrence or metastasis. Conclusions: The technique described in this preliminary study appears to be safe, feasible, and easy in our population, with satisfactory recovery of voiding function. © 2010 Elsevier Inc. All rights reserved.

 

Correspondence Address: Liang, Z.; Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China; email:zhi.lzliang@gmail.com 
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疾病资源中心  疾病资源中心
 病例分析

 王燕燕 王曙

上海交通大学附属瑞金医院内分泌科

患者,女,69岁。2009年1月无明显诱因下出现乏力,当时程度较轻,未予以重视。2009年3月患者乏力症状加重,尿色逐渐加深,大便习惯改变,颜色变淡。4月18日入我院感染科治疗,诉轻度头晕、心慌,体重减轻10kg。无肝区疼痛,无发热,无腹痛、腹泻、腹胀、里急后重,无恶性、呕吐等。入院半月前于外院就诊,查肝功能:ALT 601IU/L,AST 785IU/L,TBIL 97.7umol/L,白蛋白 41g/L,甲状腺功能:游离T3 30.6pmol/L,游离T4 51.9pmol/L,心电图示快速房颤。
 

医学数据库  医学数据库



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Copyright © 2009 Elsevier.  All Rights Reserved.  爱思唯尔版权所有



友情链接:中文版柳叶刀 | MD CONSULT | Journals CONSULT | Procedures CONSULT | eClips CONSULT | Imaging CONSULT | 论文吧 | 世界医学书库 医心网 | 前沿医学资讯网

公司简介 | 用户协议 | 条件与条款 | 隐私权政策 | 网站地图 | 联系我们

 互联网药品信息服务资格证书 | 卫生局审核意见通知书 | 药监局行政许可决定书 
电信与信息服务业务经营许可证 | 京ICP证070259号 | 京ICP备09068478号

Copyright © 2009 Elsevier.  All Rights Reserved.  爱思唯尔版权所有