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目的:探索系统保留盆腔自主神经的广泛性子宫切除术(systematic nerve sparing radical hysterectomy,SNSRH)对术后膀胱、直肠及性功能的保护作用。方法:选取2007年11月~2009年4月宁夏医科大学附属医院收治的44例宫颈癌及子宫内膜癌患者,A组24例行SNSRH,B组20例行传统根治性子宫切除术,观察SNSRH成功率,两组术后膀胱、直肠和性功能情况。结果:(1)A、B两组严格遵循Ⅲ型子宫切除术标准,手术切除范围无差异;(2)30例行SNSRH,成功保留盆腔自主神经(PAN)24例,失败6例,成功率80%;(3)A、B组平均手术时间、术中出血量差异无统计学意义;A、B组平均留置尿管时间、术后残余尿量、排气排便时间差异有统计学意义(P<0.05);(4)A组术后性功能障碍发生率明显低于B组,差异有统计学意义(P<0.05)。结论:系统保留PAN的广泛性子宫切除术对术后膀胱、直肠及性功能的恢复有一定的保护作用。
Objective: To explore the protective effects of systematic nerve sparing radical hysterectomy (SNSRH) on the bladder, rectum and sexual function after pelvic autonomic nerve preservation. METHODS: Forty-four patients with cervical cancer and endometrial cancer admitted to Affiliated Hospital of Ningxia Medical University from November 2007 to April 2009 were selected. Twenty-four patients in group A received SNSRH, and twenty patients in group B received conventional radical hysterectomy. SNSRH success rate, bladder, rectum and sexual function in both groups. Results: (1) The group A and B followed the standard of type Ⅲ hysterectomy strictly and there was no difference in the surgical resection scope. (2) 30 cases of SNSRH successfully retained pelvic autonomic nerve (PAN) in 24 cases, failed in 6 cases and the success rate 80%; (3) There was no significant difference in average operation time and blood loss between group A and group B. There was significant difference between group A and group B in terms of mean indwelling catheter time, postoperative residual urine volume, P <0.05). (4) The incidence of postoperative sexual dysfunction in group A was significantly lower than that in group B, the difference was statistically significant (P <0.05). CONCLUSIONS: The systematic preservation of extensive hysterectomy by PAN has a protective effect on the recovery of the bladder, rectum and sexual function.