【摘要】：根治性子宮與盆腔淋巴結(jié)切除術(shù)是治療早期宮頸癌主要的有效方法，且有較高的累積5年生存率高。宮頸治療后生存患者期待更好的生活質(zhì)量，生存率的升高也使得國(guó)內(nèi)外婦科腫瘤醫(yī)師醫(yī)師不斷的改進(jìn)治療方法。而最有效的常規(guī)宮頸癌根治術(shù)由于切除范圍過(guò)大容易損傷盆腔自主神經(jīng)，導(dǎo)致術(shù)后出現(xiàn)膀胱、直腸和性功能障礙。NSRH手術(shù)在早期宮頸癌治療中因保護(hù)了盆腔神經(jīng)而得到廣泛的應(yīng)用。我們?cè)鴮?duì)首次在我院就診并接受進(jìn)行了保神經(jīng)手術(shù)的患者，對(duì)其進(jìn)行術(shù)后膀胱功能、近期直腸功能評(píng)估，得出保留盆腔自主神經(jīng)根治性子宮切除術(shù)具有可行性和安全性，有利于術(shù)后膀胱、直腸功能的恢復(fù)的結(jié)論。本研究分兩部分探討NSRH術(shù)的優(yōu)勢(shì)及安全性：1、將通過(guò)調(diào)查問(wèn)卷、電話隨訪、書(shū)信隨訪形式對(duì)接受保神經(jīng)手術(shù)術(shù)后的患者遠(yuǎn)期直腸功能、性功能的調(diào)查研究；2、保神經(jīng)手術(shù)的生存分析。 保留盆腔自主神經(jīng)廣泛全子宮切除術(shù)術(shù)后患者直腸功能、性功能的調(diào)查研究 目的對(duì)NSRH手術(shù)與同期RH術(shù)術(shù)后遠(yuǎn)期直腸、性功能方面的調(diào)查研究。 方法選擇2008年03月~2013年12月期間，于廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院72例FIGO Ib1~Ⅱb期符合并接受NSRH手術(shù)（即Q-M手術(shù)分型的C1型）治療的患者，且有完整隨訪資料的患者為研究組。對(duì)照組選擇72例隨機(jī)抽取接受Q-M手術(shù)分型的C2型的宮頸癌根治術(shù)的無(wú)復(fù)發(fā)患者�；仡櫺苑治鰞山M患者在接受手術(shù)后的遠(yuǎn)期直腸功能和性功能。 結(jié)果兩組患者術(shù)后直腸功能情況調(diào)查結(jié)果：保神經(jīng)手術(shù)組（NSRH組）伴有腹瀉、便秘癥狀的比例分別為4.2%、6.9%，未保神經(jīng)手術(shù)組（RH組）的分別為33.3%、38.9%,差異顯著（P＜0.05）；兩組大便失禁情況無(wú)顯著差異（P＞0.05）兩組患者術(shù)后性功能情況調(diào)查評(píng)分結(jié)果匯總?cè)绫砹荆簝山M的除性欲望外，性興奮、性潤(rùn)滑、性高潮、滿意度、性疼痛情況和總分均有顯著差異（P＜0.05）。 結(jié)論NSRH手術(shù)在一定程度上能減輕遠(yuǎn)期直腸功能、性功能障礙的發(fā)生。 保留盆腔自主神經(jīng)根治性全子宮切除術(shù)的生存分析 目的探討NSRH術(shù)治療早期宮頸癌的療效及對(duì)患者預(yù)后的影響。 方法收集2008年03月~2013年08月廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院首次接受NSRH治療的宮頸癌患者84例，治療前由兩名及兩名以上婦科腫瘤專業(yè)醫(yī)師進(jìn)行雙合診及三合診檢查，按國(guó)際婦產(chǎn)科聯(lián)盟（International Federation ofGynecology and Obstetric，F(xiàn)IGO）2009年臨床分期診斷為Ⅰb1~Ⅱb期為研究組。為了消除偏倚，選出與相同期間、相同F(xiàn)IGO分期、同一術(shù)者的87例初次接受RH手術(shù)的宮頸癌患者與研究組進(jìn)行配對(duì)：兩組患者的年齡、體重指數(shù)(BMI)、腫瘤病理類型、臨床分期等差異均無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)果NSRH組和RH組的累積5年總生存率分別為98.6%和93.0%，中位生存時(shí)間分別為25.5個(gè)月和26個(gè)月；NSRH組和RH組的累積5年無(wú)瘤生存率分別為98.6%和90.8%，均差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。在一定程度上講NSRH手術(shù)是安全可行的。 結(jié)論NSRH用于早期宮頸癌的治療與RH手術(shù)相比，，有恢復(fù)快、保留尿管時(shí)間短、住院時(shí)間短以及長(zhǎng)期生活質(zhì)量有不同程度的改善等優(yōu)點(diǎn)的優(yōu)點(diǎn)，而且是安全有效的。
[Abstract]:Radical hysterectomy and pelvic lymphadenectomy are the main effective methods for the treatment of early cervical cancer, and the cumulative 5-year survival rate is high. Patients who survive after cervical treatment expect better quality of life. The rising survival rate also makes gynecologists and oncologists at home and abroad constantly improve the treatment methods. Radical resection of the pelvic autonomic nerve may lead to postoperative bladder, rectum and sexual dysfunction. NSRH has been widely used in the treatment of early cervical cancer because of the protection of the pelvic nerve. We have had the first time in our hospital and underwent nerve-conserving surgery for patients with postoperative bladder. Cystectomy with pelvic autonomic nerve preservation is feasible and safe, which is beneficial to the recovery of bladder and rectal function. This study is divided into two parts to explore the advantages and safety of NSRH: 1. Through questionnaires, telephone follow-up and letter follow-up, the acceptance of NSRH will be protected. Long-term rectal function and sexual function of patients after surgery; 2. Survival analysis of nerve-preserving surgery.
Investigation of rectal function and sexual function in patients with pelvic autonomic nerve preservation after total hysterectomy
Objective to investigate the long-term rectal and sexual function after NSRH operation and RH.
Methods From March 2008 to December 2013, 72 cases of cervical cancer with FIGO Ib1~II B stage conforming to and receiving NSRH operation (type C1 of Q-M operation type) and complete follow-up data were selected as the study group. 72 cases of cervical cancer with Q-M operation type C2 were randomly selected as the control group. The long-term rectal and sexual functions of the two groups were analyzed retrospectively.
Results Two groups of patients with rectal function survey results: nerve-conserving surgery group (NSRH group) with diarrhea, constipation symptoms were 4.2%, 6.9%, non-nerve-conserving surgery group (RH group) were 33.3%, 38.9%, the difference was significant (P < 0.05); two groups of patients with fecal incontinence was not significantly different (P > 0.05). The scores were summarized as shown in Table 6. Except for sexual desire, there were significant differences in sexual excitement, sexual lubrication, orgasm, satisfaction, sexual pain and total score between the two groups (P < 0.05).
Conclusion NSRH operation can reduce long-term rectal function and sexual dysfunction.
Survival analysis of pelvic autonomic nerve radical hysterectomy
Objective to investigate the efficacy and prognosis of NSRH in the treatment of early cervical cancer.
Methods From March 2008 to August 2013, 84 patients with cervical cancer who were first treated with NSRH in Cancer Hospital Affiliated to Guangxi Medical University were enrolled. Before treatment, two or more gynecological oncologists performed double and triple consulting examinations according to the International Federation of Gynecology and Obstetric (FIGO) in 2009. In order to eliminate the bias, 87 patients with cervical cancer who underwent RH for the first time were selected and matched with the study group. There were no significant differences in age, body mass index (BMI), tumor pathological type and clinical stage between the two groups.
Results The cumulative 5-year overall survival rates in NSRH and RH groups were 98.6% and 93.0% respectively, and the median survival time was 25.5 months and 26 months, respectively. The cumulative 5-year tumor-free survival rates in NSRH and RH groups were 98.6% and 90.8% respectively, with no significant difference (P > 0.05).
Conclusion Compared with RH, NSRH has the advantages of faster recovery, shorter retention time, shorter hospitalization time and better long-term quality of life.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33

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