Clinical Research Of Preserving Ureteral Branch Of Uterine Artery In Radical Hysterectomy

Objective: Evaluate the safety and efficacy of preserving the ureteral branch of uterine artery in radical hysterectomy.Methods: From September 2016 to February 2019,the clinical data and postoperative follow-up of patients with cervical cancer treated by laparoscopic radical hysterectomy in the second ward of gynecological tumors in the affiliated tumor hospital of Guangxi medical university were collected.ICG angiography was applied to observe the blood supply in the lower ureter undergoing operation.Patho-logical examination was performed on all in vitro specimens.SPSS 23.0 statistical software was used to analyze the collected data.Results: The mean operation time of the non-preservation group(251.8min)was longer than that of the preservation group(239.6min).The average intraoperative blood loss in the non-preservation group(190.4ml)was higher than that in the preservation group(162.7ml).But the difference was not statistically significant(P>0.05).The mean postoperative hospital stay without preserving group(11.1d)was longer than that in the preserving group(8.2d),and the difference was statistically significant(P<0.01).There were 12 cases of ureterovaginal fistula(5.3%)and 3 cases of hydronephrosis and ureterostenosis(1.3%)in the non-preserving group.No urinary complications occurred in the preserving group.Intraoperative ICGA showed that the lower ureteral blood supply with preserving ureteral branch of uterine artery was better than that without preserving group.Among the 12 patients with post-operative ureteral injury,11 cases(91.7%)occurred at and near the ureteral tunnel,and 1 case of upper ureter occurred postoperatively.No metastasis was found in 5 cases of uterine artery,3 cases of uterine vein and 14 cases of para-uterine artery tissue.1 case of IIA1 patient had para-uterine arterial tissue metastasis(6.7%).Univariate analysis was performed on 251 patients.There was a significant correlation between the tumor diameter,pelvic lymph node metastasis,depth invasion,and parametrial tissue involvement.And the difference was statistically significant(P<0.05).Logistics analysis found that pelvic lymph node metastasis is an independent risk factor for parametrial tissue metastasis(P<0.05).Tumor diameter >2cm,pelvic lymph node metastasis positive and depth invasion >1/2 is related to the parametrial tissue metastasis(P<0.01).Conclusion: 1.Preserving ureteral branches of uterine artery in radical hysterectomy can reduce postoperative the ureteral ischemia,risk of ureteral ischemic necrosis and the probability of ureteral fibrosis leading to hydronephrosis.2.It is the first report in the literature to evaluate the blood supply of the lower ureter by ICG angiography,which is an intuitive and reliable technique for evaluating the preserving ureteral branches of uterine artery.3.The risk of metastasis is increased when there is parametrial tissue infiltration.In particular,patients with pelvic lymph node metastasis and depth invasion >1/2 and tumor diameter >2cm(FIGO 2018 stage IB2 and above)were at increased risk of cancer metastasis,which can be recommend to traditional radical hysterectomy in cervical cancer.The risk of metastasis is lower for FIGO2018 IB1 stage and earlier patients.It may be considered to preserve the ureteral branch of uterine artery in radical hysterectomy.4.Preserving the ureteral branch of the uterine artery in radical hysterectomy can reduce the postoperative hospital stay.