ABSTRACT
Objective To compare the efficacy and complications of the two surgical methods (between type Ⅰ hysterectomy and type Ⅱ hysterectomy),and to explore the feasibility of type Ⅰ hysterectomy in stage ⅠA cervical cancer.Methods The study group,92 cases(48 cases of stage ⅠA1,44 cases of stage ⅠA2) were performed with type Ⅰ hysterectomy plus selective pelvic lymph node dissection;the control group,93 cases (49 cases of stage ⅠA1,44 cases of ⅠA2) were performed with type Ⅱ hysterectomy plus selective pelvic lymph node dissection.Results The survival rate of 5 years and 10 years in study group were 100 ％ (92/92),100 ％ (74/74) and that in control group were 100 ％ (93/93),100 ％(66/66),respectively.There were no signicant difference between the two group (both P ＞ 0.05).When compared with the control group,the urinary tract infection of the study group was significantly reduced (0 versus 13.99 ％,P ＜ 0.05).Moreover,there were a shorter surgical duration [(96.14±17.20) min vs (116.82±16.30) min].The hemorrhage [(117.35±39.61) ml] and blood transfusion (0 ml) in study group was less common than those in control group [(201.74±46.25) ml,(82.07±16.32) ml] (all P ＜ 0.01).Conclusion There are no difference of 5-year and l0-year survival rate in stage ⅠA patients with type Ⅰ or type Ⅱ hysterectomy,however,the rate of the postoperative urinary tract infection in the former is lower than that in the latter,and also there are a shorter surgical duration,less hemorrhage and reduced blood transfusion requirements in study group.Therefore,type Ⅰ hysterectomy can be effective and applicable for the patients of stage ⅠA cervical cancer.
ABSTRACT
Objective To explore the surgical extent and to improve the surgical techniques of the Piver class Ⅲ hysterectomy on invasivc cervical cancer,so as to reduce the urinary tract complications,shorten the surgical duration,decrease the hemorrhage and blood transfusion.Methods The study group,196 cases with stages Ⅰ b and Ⅱ a carcinoma of the cervix underwent the modified Piver class Ⅲ hysterectomy from June 2000 to May 2005.The control group,176 cases of the same stages underwent the Pivet class Ⅲ hysterectomy between June 1994 and May 1999.The modified Piver class Ⅲ hysterectomy mainly include the surgical extent and some surgical techniques as follows.The cervicovesical and vesicovaginal space are separated with assistance of electrotome.Half of the uterosacral ligaments are removed with electrotome.The tunnel of the ureters is separated and penetrated or not. The anterior leaf of the cervicovesical ligaments is removed and the uterine artery are removed at the same time.while the ureter branch from the uterine artery are preserved.When the ureters aIe drawn to the lateral side of the body with an "S" hook and the urocyst lateral recessus are expanded.the cardinal ligaments can be exposed and be removed of 3/4.But part of the inferior of these ligaments should be preserved.The paracolpium are resected about 2 cm.2-3 cm tissue of the vagina is removed.Results Compare with the control group,the urinary tract complications of the study group were significantly reduced(51.1%versus 23.0%,P<0.01).There were a shorter surgical duration[(132±20)min],less of the hemorrhage[(322±100) ml]and blood transfusion[(154±79)ml] in the study group than those in the control group(all P<0.05).While,there was no significant difference at the survival rates of 5 years between the two groups (87.8% versus 88.6%.P=0.793).Conclusion The modified Piver class Ⅲ hysterectomy is effective and applicable for patients with cervical cancer.