目的：探讨在达芬奇机器人手术系统（ da vinci）下保留盆腔自主神经广泛性子宫切除术（ NSRH）改善患者术后盆腔器官功能障碍并发症的可行性。方法选择西京医院妇产科FIGO分期为ⅠA ～ⅡA期的57例宫颈癌患者实施da Vinci下NSRH的根治术。观察手术时间、术中出血量，以及韧带、阴道切除长度和膀胱直肠功能变化。结果57例手术均获成功。平均手术时间165 min（145～220 min）；术中平均失血量55 ml（20～85 ml）；平均清扫淋巴结31枚（13～37枚）。韧带、阴道切除长度达PiverⅢ型标准，切缘病理检查均无癌细胞浸润。所有病例术后24 h内恢复肛门排气，留置尿管时间（6.3±0.9）d，术后5日尿管拔除率达91.23％，尿流动力学检测结果与术前相比较差异无统计学意义（ P＞0.05）。结论 da Vinci机器人手术系统下对于神经的辨认更加清晰、微观，全方位神经保留对改善患者术后膀胱直肠功能效果良好，达到提高患者生存质量的目的。%Objectiv e To investigate the feasibility and the effectiveness of the daVinci Surgery System in the improvement of postoperative pelvic organ dysfunction after nerve sparing radical hysterectomy( NSRH)for cervical cancer.Methods Fiftys-even pa-tients with FIGO stage I A-Ⅱ A cervical cancer in our hospital were selected to receive NSRH performed by using the daVinci Surgery System.The duration of surgery,blood loss,excision extent of ligament and the vagina were observed .The bladder and rectum function after the operation was also observed.Re sults The operations were completed successfully in all patients.The average operation time was 165(145~220)min.The median intraoperative blood loss was 55(20~85)mL.The average number of dissected lymph nodes were 31(13~37) .The length of resected vagina and paracervical tissues in the operations all reached the requirement of Piver Ⅲ cervical cancer operation.No cancer invasion was observed at excision edge that was confirmed by pathological test.The exhaust was restored in all patients within 24 hour after operation and the average days of urethral catheter remaining were 6.3±0.9 days.Urinary catheter re-moval rate reached 91.23%on the fifth day after operation.Urodynamic test results were significant difference when compared with pre-operation.Conclusion The daVinci Surgery System can identify the pelvic autonomic nerve more clearly and has great superiority in preservation of the never function.NSRH for cervical cancer performed by using the system can improve the postoperative rectal and bladder function,and thus achieve the goal of improvement of the patient's quality of survival.
展开▼
