ABSTRACT
Objective@#To introduce the laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branched and to evaluate its feasibility and safety for cervical cancer and its effect to bladder function and to provide some reference to simplify the surgical procedures of laparoscopic type C1 hysterectomy.@*Methods@#The clinicopathologic data of the patients with stage ⅠA2~ⅡB cervical cancer and who underwent the laparoscopic C1 hysterectomy based on anatomic landmark of the uterus deep vein and its branches between March 2010 and December 2015 was retrospectively analysed.@*Results@#A total of 99 patients received laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches, in which 93 patients reserved unilateral or bilateral pelvic autonomic nerve successfully, the other 6 patients were transfered to receive type C2 hysterectomy due to adhesions, bleeding or the low possibility of curative resection. The failure rate of the surgery was 6.1% (6/99). The average age of these 93 patients was 44.4±8.2 years (range 25~61 years) and there was one case of stage ⅠA2, 84 stage ⅠB1, 2 stage ⅠB2, 5 stage ⅡA1 and 1 stage ⅡB. The number of patients with squamous cell carcinoma was 67, adenocarcinoma was 19, adenosquamous carcinoma was 3, small cell neuroendocrine carcinoma was 3 and mixed type was 1. The average operation time was 4.1±0.5 h, the average amount of intraoperative blood loss was 103.8±84.0 ml and the mean number of excisional pelvic lymph nodes was 29.7±8.9. There was no patient with positive parametrial margin, positive vaginal margin or intraoperative ureteral injury. The postoperative catheter extraction time was 20.3±8.4 d. The median follow-up time was 20 months (rang 5~44 months), the long-term bladder dysfunction rate was 8.6% (8/93). The numbers of locally uncontrolled and distantly metastasis case were both one and both patients died. The fatality rate were 2.2% (2/93). The two-year disease-free survival and overall survival rate were 97.6% and 96.2%, respectively.@*Conclusion@#Laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches is a safe and feasible treatment method for cervical cancer and it provides a new approach for simplifying the surgical procedures of laparoscopic type C1 hysterectomy.
ABSTRACT
Bladder function is controlled by the hypogastric nerves (sympathetic) and pelvic splanchnic nerves (parasympathetic) , and these two nerve fibers intermingle to form the pelvic plexus. Pelvic surgery was one of the important modalities being used in pelvis-gynecology, but it was commonly found that the modality could cause bladder dysfunction because of its damage to the pelvic plexus. Pelvis-gynecologic surgeries like Pive Ⅱ-Ⅳ radical hysterectomy (RH), total vaginectomy, Hartman, Dixon, and posterior pelvic exenteration are among the most important causes of urinary dysfunction. Recently, urinary dysfunction has become the major issue for patients undergoing pelvic surgery in terms of quality-of-life. Pelvic autonomic nerve-sparing (PANS) protects postsurgical bladder function in radical RH and other pelvic surgery. The review tried to discuss different types of PANS being used in variety of pelvis-gynecologic surgery. Type Ⅰ PANS can be performed in Piver Ⅱ RH in patients with endometrioid cancer, and urinary catheter will be removed 3 days after operation. Type Ⅱ PANS is used in Piver Ⅲ RH, and the catheter can be successfully removed 7 days after surgery. Sometimes, type Ⅲ PANS is administered in one-side tumor-free cardinal ligament resection, and the patients will retain their catheter for 3 weeks postoperatively. Type Ⅱ or type Ⅲ PANS may be used in total vaginectomy, Hartman, Dixon, and posterior pelvic exenteration.