Clinical Study For Laparoscopic Nerve-sparing Radical Surgery For Cervical Cancer

ObjectiveTo explore the feasibility,safety and therapeutic efficacy of laparoscopic nerve plane-sparing radical hysterectomy for cervical cancer.MethodsThis is a retrospective analysis,including 128 patients who were treated in our hospital from February 2014 to March 2016.Patients were randomlly divided into two groups based on whether laparoscopy was applied,the nerve-sparing radical hysterectomy through laparoscopic group and the abdominal nerve-sparing radical hysterectomy group.All patients were thoroughly informed about the surgical procedures and risks before they signed a consent form.We assessed the general clinical installment,the time of intraoperation,intraoperative bleeding,the time of hospital stay,the rate of complications,and the function of pelvic organs(including bladder,intestine and sexual function).ResultsThere was no significant difference between the observation group and the control group in age,body mass index,and previous operation,stage of International Union of Obstetrics and Gynecology(FIGO)and pathological type(P>0.05).In observation group,the operative time was(303.7 ± 67.4)min,median blood loss of 176.9 ml,the rate of blood transfusion of 4.69%,median length of hospital of 9.2days;In observation group,the operative time was(272.3±57.4)min,median blood loss of 473.4 ml,the rate of blood transfusion of 51.56%,median length of hospital of 10.9 days.There was significant difference in those items(P<0.05).And there was no difference in the function of pelvic organs and the rate of postoperative complications between the two groups(P>0.05).ConclusionTreatment of cervical cancer by laparoscopic nerve-sparing radical hysterectomy,can achieve the effect of nerve retention,but also can significantly reduce the blood transfusion and hospital days,and improve the quality of life of patients after surgery as compared to conventional radical surgery.Objective:To evaluate clinical application value of laparoscopic nerve-sparing radical surgery for cervical cancer.Methods:A computer system evaluation method adopted to retrieve MEDLINE,WEB OF SITE,VIP,China National Knowledge(CNKI),Articles database,retrieve relevant professional literature,retrieval time for the deadline to June 2014.To collect relevantrandomized controlled trials of the conservative surgery with drugs in the treatment of endometriosis.To take gestrinone as the representative drug compared with other commonly used drugs in the treatment of endometriosis,and to meta-analysis the data in the aspect of pain relief,relapse,pregnancy and side effects.According to the Cochrane systematic review program to remove the literature which does not meet the research and the data is unreliable,and to meta-analysis with RevMan5.2 software process data.Results:1.Three trials which argued about the comparison of laparoscopic nerve-sparing radical hysterectomy(LNSRH)and abdominal nerve-sparing radical hysterectomy(ANSRH)involving 258 patients were included in the study.Compared with ANSRH,LNSRH ①significantly increased operation duration(MD=38.39,95%CI[24.35,52.44],P<0.00001);②significantly reduced the rate of blood transfusion(RR=0.08,95%CI[0.03,0.20],P<0.00001):③significantly shortened the length of hospital stay(MD=-1.61,95%CI[-2.68,-0.53],P=0.003);④ had no significant difference in the number of cases whose residual urine was less than 100ml(RR=1.04,95%CI[0.87,1.24],P=0.69).2.Fourteen trials which argued about the comparison of laparoscopic nerve-sparing radical hysterectomy(LNSRH)and laparoscopic radical hysterectomy(LRH)involving 1145 patients were included in the study.Compared with LRH,LNSRH①had no significant difference in estimated blood loss during the operation(MD=-4.27,95%CI[-19.32,10.78],P=0.58);②significantly shortened the duration of the postoperative catheterization(MD=-7.41,95%CI[-8.77,-6.05],P<0.00001)and the period of passage of gas by anus(MD=-0.72,95%CI[-0.73,-0.57],P<0.00001);③shortened the length of hospital stay(MD=-1.61,95%CI[-2.68,-0.53],P=0.003);④significantly reduced the incidence of urinary retention(RR=0.25,95%CI[0.13,0.46],P<0.0001),constipation RR= 0.45,95%CI[0.23,0.85],P=0.01),and fecal incontinence(RR= 0.14,95%CI[0.04,0.56],P=0.005).Conclusion:1.The comparison of laparoscopic nerve-sparing radical hysterectomy(LNSRH)and abdominal nerve-sparing radical hysterectomy(ANSRH),LNSRH group is an effective surgery,intraoperative blood loss,but significantly reduced significantly reduced the number of blood transfusions,shorten hospitalization time,there was no significant difference in the bladder,bowel and sexual function,the postoperative complications and no obvious difference.2.The comparison of laparoscopic nerve-sparing radical hysterectomy(LNSRH)and laparoscopic radical hysterectomy(LRH).LNSRH can significantly reduce the blood loss of operation,shorten the duration of hospital stay,improve the function of bladder and intestine,and reduce the rate of urinary retention,constipation,and fecal incontinence.However,the duration of operation get longer compared to ANSRH.