Safety and prognosis analysis of different regimens in the treatment of patients with stage Ⅲ cervical cancer / 中华放射医学与防护杂志

Objective:To compare the toxicity and prognosis of patients with stage Ⅲ cervical cancer treated using different regimens.Methods:A retrospective analysis was carried out for 194 patients with stage Ⅲ cervical cancer determined according to the revised 2018 International Federation of Gynecology and Obstetrics staging system (16 cases of stage Ⅲ A, 23 cases of stage Ⅲ B, 136 cases of stage Ⅲ C1, and 19 cases of stage Ⅲ C2) admitted to the First Affiliated Hospital of Soochow University from January 2010 to December 2020. They were divided into a radical radiotherapy±chemotherapy group (81 cases) and a radical hysterectomy + radiotherapy±chemotherapy group (113 cases) according to different treatment method. The difference in toxicity between the two groups was determined using the χ2 test. The survival curves and progression-free survival curves were plotted using the Kaplan-Meier method, and the Log rank test was also performed. The differences in toxicity and prognosis were further analyzed in 136 patients with stage Ⅲ C1 cervical cancer result patients in the radical radiotherapy±chemotherapy group were more likely to have hemoglobin decline ( χ2=10.68, P=0.004), rectal mucositis ( χ2=14.41, P=0.001), and vaginal fistula ( χ2=7.16, P=0.012) of grades 3 and 4. Patients in the radical hysterectomy+ radiotherapy±chemotherapy group were more likely to have increased aspartate aminotransferase ( χ2=10.96, P=0.002) and alanine aminotransferase ( χ2=8.49, P=0.010). The differences were statistically significant. The 5-year progression-free survival rate of the radical radiotherapy±chemotherapy group was 58.3%, which was lower than that of the radical hysterectomy + radiotherapy±chemotherapy group (74.5%; χ2=5.33, P=0.021). Among the 136 patients with stage Ⅲ C1 cervical cancer, the ones in the radical radiotherapy±chemotherapy group (34 cases) were more likely to develop rectal mucositis ( χ2=13.25, P=0.003), while the ones in the radical hysterectomy + radiotherapy±chemotherapy group (102 cases) were more likely to have elevated aspartate aminotransferase ( χ2=6.18, P=0.046). The differences were statistically significant. The 5-year survival rates of the radical radiotherapy±chemotherapy group and the radical hysterectomy+ radiotherapy±chemotherapy group were 85.5% and 86.3%, respectively. The difference was not statistically significant ( P=0.893). The 5-year progression-free survival rates of the radical radiotherapy±chemotherapy group and the radical hysterectomy + radiotherapy±chemotherapy group were 65.6% and 77.1%, respectively. The difference was not statistically significant ( P=0.244). Conclusions:For patients with stage Ⅲ cervical cancer, the ones in the radical radiotherapy±chemotherapy group were more likely to progress and have a poorer prognosis compared with the ones in the radical hysterectomy+ radiotherapy±chemotherapy group. For patients with stage Ⅲ C1 cervical cancer, there was no significant difference in the prognosis of patients between the groups. The two treatment method lead to different toxicity, with no obvious advantages and disadvantages. Considering the risks and economic burdens caused by surgery, radical radiotherapy and chemotherapy is recommended for patients with stage Ⅲ C1 cervical cancer.

Research progress on the definition of intermediate risk factors and postoperative adjuvant therapy for early cervical cancer / 中华放射肿瘤学杂志

Cervical cancer is still a common gynecolgical tumor in China. Radical surgery is often the first choice for the treatment of early stage cervical cancer (FIGO stage ⅠB-ⅡA), and postoperative pathological examination often has adverse prognostic factors affecting the survival. According to the NCCN guidelines, patients with cervical cancer who meet Sedlis criteria and have intermediate-risk factors (lymphatic vascular space involvement, tumor size or deep interstitial infiltration) are recommended to receive concurrent chemotherapy with postoperative pelvic external irradiation ± cisplatin. However, the diagnostic criteria, indications and methods of adjuvant therapy for patients with intermediate risk factors after early cervical cancer surgery are still controversial. In this article, research progress on the definition of intermediate risk factors for early cervical cancer after radical hysterectomy and adjuvant treatment was mainly reviewed.

Timing of urinary catheter removal after radical hysterectomy for cancer of the cervix and uterus: A single-institution observational study / Philippine Journal of Obstetrics and Gynecology

Background and Objective@#Radical hysterectomy remains to be the first surgery for early‑stage cervical and selected stage 2 endometrial carcinoma. Functional disorders of the lower urinary tract are the foremost common complications following radical surgery necessitating catheterization. This study was undertaken to determine the number of postoperative days (POD) of the removal of urinary catheters after hysterectomy and assess the practicability of earlier removal of the catheter without compromising the bladder function@*Methodology@#A descriptive observational study of patients who underwent Type 2 or 3 hysterectomy for cervical or endometrial carcinoma. Clinical, intraoperative, and anesthesia records and results of the histopathologic reports of every patient were reviewed. Demographic, clinical, and histopathologic data needed during this review were recorded. Descriptive statistics were used.@*Results@#Between January 2016 and December 2019, a complete 45 patients underwent radical hysterectomy (43 patients for cervical cancer and a pair for endometrial carcinoma), with a median age of 50 years. The mean operative time is 2.5 h and also the average blood loss is 500 ml. The mean size of the cervical tumor was 2.2 cm, the mean length of the vagina was 2.5 cm, and the mean lateral width of parametria was 3.6 cm. Catheters were removed between the 3rd and 20th (mean = 6 days) POD. All patients had adequate spontaneous void within 6 h after removal. Five patients had their catheters removed beyond 7 days, 3 patients between POD 8 and POD 14, and 2 patients between days POD 15 and POD 20. All patients were able to return to bladder function within 3 weeks of catheterization.@*Conclusion@#The outcome showed that earlier removal of catheter seems to be a practical and safe option compared to long‑term catheterization for patients who underwent radical hysterectomy without causing morbidities

Chinese expert consensus on nerve-sparing radical hysterectomy for cervical cancer / 中华肿瘤杂志

Cervical cancer is the most common gynecologic malignancy. Radical hysterectomy for early-stage cervical cancer could cause damage to pelvic autonomic nerves, leading to postoperative urination, defecation and sexual dysfunction. In order to improve the postoperative quality of life, the international Querleu-Morrow (Q-M) surgical classification system recommends the nerve-sparing radical hysterectomy (type-C1) as the mainstay operation. The Gynecologic Oncology Group affiliated to Chinese Obstetricians and Gynecologists Association has invited a number of domestic specialists and conducted in-depth discussions on key issues such as anatomical basis, surgical indications, techniques, postoperative evaluation for nerve-sparing radical hysterectomy. Finally, the specialists reach a consensus to guide the standardized application of this procedure in China.

Outcomes of Advanced Oncological Laparoscopic Procedures in a Tertiary Care Center

Introduction: Advanced laparoscopic procedures are performed in oncology for almost all visceral sites. We present theoncological and functional outcomes of series of patients who underwent advanced laparoscopic oncological procedures inour tertiary care center.Materials and Methods: We analyzed 34 consecutive patients who underwent advanced laparoscopic oncological proceduresby the same surgeon in the department of surgical oncology during the period of 2015–2019. Five patients underwentlaparoscopic type C1 radical hysterectomy. Laparoscopic abdominoperineal resection was done for six patients, laparoscopicstaging for carcinoma endometrium for seven patients, thoracoscopic esophagectomy for five patients, laparoscopic-assisteddistal gastrectomy for two patients, and laparoscopic staging for ovarian cancer for four patients. Laparoscopic right radicalnephrectomy and laparoscopic right hemicolectomy were done for one patient each.Results: Out of the five patients who underwent laparoscopic Type C1 radical hysterectomy, one patient had residual IB1disease. There was no bladder morbidity and all patients are alive without disease. Two patients who underwent laparoscopicabdominoperineal resection and one patient after thoracoscopic esophagectomy developed disease recurrence. None of thepatients who underwent other procedures had major morbidity or disease recurrence.Conclusion: Advanced laparoscopic procedures are feasible in oncology with minimal morbidity and good oncological outcome.The nodal yield and oncological outcome improve with increasing experience of the surgeon in minimally invasive surgicaloncology.

A ten-year retrospective study on the survival outcomes among post-hysterectomy cervical cancer patients / Philippine Journal of Obstetrics and Gynecology

Background@#Cervical cancer is the most common gynecologic malignancy in the Philippines despite being a preventable disease. Radical hysterectomy with pelvic lymphadenectomy is considered the standard surgical treatment of choice for patients with cervical cancer confined to the cervix up to the upper vagina. However, recent studies show that a less radical approach can be offered to these patients with comparable outcomes to radical hysterectomy, but with lesser perioperative and post-operative morbidity.@*Objectives@#The purpose of this study was to compare the outcomes in terms of recurrence and survival among cervical cancer patients who underwent simple hysterectomy and radical hysterectomy seen in a tertiary government hospital.@* Methods@#The records of all cervical cancer patients who underwent radical hysterectomy and simple hysterectomy for the past ten years were reviewed.@*Results@#The incidence of cervical cancer patients who underwent simple hysterectomy from 2009-2018 is 0.37 per 100 person years or 0.592:16, lower than 1:16 ratio from 1964-1974, as reported by Manalo and Sotto.1 Only 9 out of 42 patients who underwent simple hysterectomy had cervical cancer screening within 1 year prior to surgery.@*Conclusion@#The most common indication for surgery was myoma uteri. Those who underwent radical hysterectomy had better recurrence free survival and overall survival than those who had simple hysterectomy.

Laparoscopic Radical Hysterectomy for Early Stage Cervical Cancers – A Single Team Experience

Current evidence on the efficacy and safety of Laparoscopic Radical Hysterectomy for early stage cervical cancer is adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit. This study aims to present our single unit experience of Laparoscopic Radical Hysterectomy performed for early stage cervical cancers. Methods: 74 laparoscopic radical hysterectomies performed for early stage cervical cancers from 2012 to 2017 were reviewed. Results: Key efficacyoutcomes evaluated were completing the procedure without conversion to open surgery ( conversion rate – 3/74),the mean operating time (144 mts), intra operative complications ( rectal injury 2/74, primary hemorrhage 1/74), post operative complications ( ureteric fistula 2/74, vescico vaginal fistula 1/74 , port site hernia 1/74), number of LN removed ( mean - 14 LN on each side), recovery time (6 hrs on average ) and length of hospital stay (average – 5days); lone term outcomes viz recurrence rate and % year survival are under study. Conclusion: Our initial experience indicate that laparoscopic radical hysterectomy is safe ,feasible and effective with low morbidity and with comparable outcome to open approach; It does not compromise oncological radicality of resection; short term results are promising; long term results are awaited.

Clinical Effect of Laparoscopic Radical Hysterectomy on Cervical Squamous Cell Carcinoma / 中国医科大学学报

Objective To evaluate the clinical efficacy of laparoscopic radical hysterectomy and pelvic lymph node dissection (PLND) in cervical squamous cell carcinoma (CSCC). Methods The clinical data of 83 CSCC patients in our hospital were retrospectively analyzed. The open surgery group (n = 43) underwent traditional transabdominal radical hysterectomy and PLND, while the laparoscopy group (n = 40) underwent laparoscopic radical hysterectomy and PLND. Intraoperative and postoperative indices were compared between the two groups. Results The intraoperative bleeding volume in stage ⅠB1 and ⅡAl patients in the open surgery group was greater than in the laparoscopy group. The operative duration was shorter and fewer lymph nodes were dissected in the open surgery group than in the laparoscopy group (P ＜ 0.05). The time to flatus, fever duration, and hospital stay in stage ⅠB1 and ⅡA1 patients in the open surgery group were longer than in the laparoscopy group (P ＜ 0.05). The frequency of painkiller use in stage ⅡA1 patients in the open surgery group was greater than in the laparoscopy group (P ＜ 0.05). There was no statistical difference in the incidence of intraoperative and postoperative complications between the ⅠB1 and ⅡA1 groups (P＞ 0.05). The physical fitness and social function scores and the adverse effects were significantly different in the open surgery group from those in the laparoscopy group (P ＜ 0.05). Conclusion Laparoscopic radical hysterectomy and PLND for CSCC can reduce intraoperative bleeding volume, increase the number of lymph nodes dissected, shorten the fever duration and hospital stay, and increase the quality of life.

Comparative Effectiveness of Abdominal versus Laparoscopic Radical Hysterectomy for Cervical Cancer in the Postdissemination Era / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Despite the benefits of minimally invasive surgery for cervical cancer, there are a lack of randomized trials comparing laparoscopic radical hysterectomy and abdominal radical hysterectomy. We compared morbidity, cost of care, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. MATERIALS AND METHODS: We used the Korean nationwide database to identify women with cervical cancer who underwent radical hysterectomy from January 1, 2011 to December 31, 2014. Patients who underwent abdominal radical hysterectomy were compared to those who underwent laparoscopic radical hysterectomy. Perioperative morbidity, the use of adjuvant therapy, and survival were evaluated after propensity score balancing. RESULTS: We identified 6,335 patients, including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger, had a more recent year of diagnosis, and were treated in the metropolitan area were more likely to undergo a laparoscopic procedure (p < 0.001). Compared to abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with lower rates of complication, fewertransfusions, a shorter hospital stay, less adjuvant therapy, and reduced total medical costs (p < 0.001). Laparoscopic surgery was associated with a better overall survival than abdominal operation (hazard ratio, 0.74; 95% confidence interval, 0.64 to 0.85). CONCLUSION: In the postdissemination era, laparoscopic radical hysterectomy was associated with more favorable morbidity profiles, a lower cost of care, and comparable survival than abdominal radical hysterectomy.

Clinical effect analysis of electrostimulation combined with biofeedback therapy for patients with dysuria after radical hysterectomy / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the clinical efficacy and safety of electrostimulation combined with biofeedback therapy for patients with dysuria after radical hysterectomy and to provide clinical reference for the evaluation of safety of electrostimulation for tumors.METHODS: Totally 40 patients with dysuria which presented two weeks after radical hysterectomy for cervical cancer in Foshan First People's Hospita were enrolled as research subjects,and they were randomly assigned into control group and experimental group,each with 20 cases.Patients in control group only received standard treatment,while standard treatment combined with electrostimulation and biofeedback treatment in sacral nerve root surface projection area,bladder area,vaginal respectively were carried out in experimental group.The baseline condition of dysuria of all cases were evaluated in two weeks after radical surgery.The therapeutic effect in the patients in two groups were evaluated according to the recovery of bladder sensory function,international lower urinary tract symptom score,urinary symptom distress score and urodynamic measurement at 8 weeks and 12 weeks after the operation,respectively.Also,regular and normative surveillance and follow-up for tumor were implemented.RESULTS: Through our study,we found that electrical stimulation combined with biofeedback thearpy will greatly shorten the recovery time of bladder sensory function,and 12 weeks after the operation,the number of patients who had normal bladder sensory function in experimental group was twice as many as that of the control group(16/8).In addition,at 8 and 12 weeks after operation,all indexs of the urinary symptom disturbance score and international lower urinary tract symptom score at the same period in the experimental group were superior to those in control group(P<0.05).Furthermore,the pressure of bladder detrusor muscle at 12 weeks after operation was(44.31±5.51)cm H2 O(1 cm H2 O=0.098 k Pa)in experimental group,which was close to the normal level,while it was only(38.11±5.81)cm H2 O in control group,showing a significant difference(P<0.05).All patients were followed up more than three years and no evidence of tumor recurrence was found.CONCLUSION: Low-frequency electrical stimulation combined with biofeedback treatment is safe and effective for patients wtih dysuria after radical hysterectomy,which can shorten the recovery time of dysuria and improve the quality of life of patients.

Current status and controversy of nerve-sparing radical hysterectomy for cercical cancer / 中国实用妇科与产科杂志

Perineural invasion in early-stage cervical cancer,is a new risk factor for the prognosis of cervical cancer.There may be a certain potential risk in retaining nerves and this is the reason why nerve-sparing radical hysterectomy(NSRH)is an important hot topic in clinical research at present.The aim to study PNI in cervical cancer is to develop clear indications for NSRH,in order to show the advantage of this surgical technique.PNI is one of the main factors affecting NSRH indications.Therefore,it is necessary to clarify the indications for NSRH,and it is imperative.

Tailoring radicality in early cervical cancer: how far can we go? / 부인종양

Today, the patient who is diagnosed with early cervical cancer is offered a variety of treatments apart from standard therapy. Patients can be treated with a less radical hysterectomy (RH) regarding parametrectomy, a trachelectomy either vaginal or abdominal, and this can be performed through a minimal invasive or open procedure. All this in combination with nerve sparing and/or sentinel node technique. Level 1 evidence for the oncological safety of all these modifications is only available from 3 randomized controlled trials (RCTs). Two RCTs on more or less radical parametrectomy both showed that oncological safety was not compromised by doing less radical surgery. Because of the heterogeneity of the patient population and the high frequency of adjuvant radiotherapy, the true impact of surgical radicality cannot be assessed. Regarding the issue of oncological safety of fertility sparing treatments, case-control and retrospective case series suggest that trachelectomy is safe as long as the tumor diameter does not exceed 2 cm. Recently, both a RCT and 2 case-control studies showed a survival benefit for open surgery compared to minimally invasive surgery, whereas many previous case-control and retrospective case series on this subject did not show impaired oncological safety. In a case-control study the survival benefit for open surgery was restricted to the group of patients with a tumor diameter more than 2 cm. Although modifications of the traditional open RH seem safe for tumors with a diameter less than 2 cm, ongoing prospective RCTs and observational studies should give the final answer.

Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB–IIB cervical cancer / 부인종양

OBJECTIVE: To examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy. METHODS: This is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB–IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence. RESULTS: There were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%. CONCLUSION: Surgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.

Predicting factors for resumption of spontaneous voiding following nerve-sparing radical hysterectomy / 부인종양

OBJECTIVE: To determine factors affecting voiding recovery on the day of Foley catheter removal (postoperative day 7, POD7) after nerve-sparing radical hysterectomy (NSRH) for early-stage cervical cancer. METHODS: Early-stage cervical cancer patients, who underwent type C1 radical hysterectomy between January 2006 and June 2016 were included. Clinical and pathological data were reviewed. Association between inability to attain adequate voiding function on POD7 and potential predicting factors were evaluated in univariate and multivariate analysis. RESULTS: Of 755 patients, 383 (50.7%) resumed adequate voiding function on POD7 while 372 (49.3%) did not. Tumor size was larger in patients whose voiding function was inadequate (2.5 vs. 2.0 cm, p=0.001). Lengths of resected parametria and adjacent vagina were more extensive in patients with inadequate voiding function (p 4 cm (p 4 cm, postoperative urinary tract infection, and primary surgeon were significantly associated with inability to attain adequate voiding function on POD7. CONCLUSION: Extent of disease represented by tumor size, urinary tract infection as well as individual surgeon's technique independently predict resumption of adequate voiding function on POD7 following NSRH.

Laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches for cervical cancer / 中华肿瘤杂志

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.

Effect of lidocaine infusion on the stress hormone level and the NK cell cytotoxicity in patients undergoing radical hysterectomy / 临床麻醉学杂志

Objective To discuss the effects of lidocaine infusion on perioperative immune function by evaluating the levels of stress hormone and natural killer (NK) cell cytotoxicity.Methods Thirty-five patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 35-65 yr,undergoing elective radical hysterectomy,were randomized into lidocaine group (group L)and control group (group C).Fifteen minutes before anesthesia induction,a bolus of 1.5 mg/kg of lidocaine was administered iv.to each patient in group L and followed by a continuous infusion at 1.5 mg·kg-1 ·h-1 lasting to the end of surgery.Meanwhile,the patients in group C received the same volume of saline.Venous blood samples were collected individually 24 h before the operation,the end of the operation and 48 h after the operation.Levels of prostaglandin,epinephrine and norepinephrine were assayed by ELISA kits.NK Cells were obtained by CD56 antibody magnetic isolation.The cytotoxicity of NK cell was detected by LDH releasing assay,and phosphor-protein kinase A (p-PKA)and protein kinase A (PKA) were detected by Western blotting.Results There were no significantly different in the plasm levels of PGF2,EP1 and NE.The plasm levels of prostaglandin (562.5±98.2 vs.663.2±119.0) pg/ml,epinephrine (24.9±4.8 vs.29.7±3.5) pg/ml and norepinephrine (408.3 ±47.2 vs.499.6±45.6) pg/ml in patients of group L were lower than those in group C (P＜0.05)48 h after the surgery.The cytotoxicity of NK cell was higher in group L than that in group C (44.1 ±5.0 vs.37.1±5.5)％ (P＜0.05) 48 h after the surgery.The ratio of p-PKA/PKA was lower in group L than that in guoup C (0.060±0.008 vs.0.099±0.011) (P＜0.05) at the end of the surgery.Conclusion Perioperative intravenous lidocaine infusion can reduce the level of plasma catecholamine and PGE2,and protect the cytotoxicity of NK cell,possibly via inhibiting of cAMP-PKA signaling pathway.

Comparison of the rate and inlfuence factors of intraoperative and postoperative complications of cervical cancer treated by laparoscopic radical hysterectomy / 中国内镜杂志

Objective Through comparative study of the rate and influence factors of intraoperative and postoperative complications of cervical cancer after laparoscopic radical hysterectomy which to guide the clinical practice of this kind of surgery in the future. Methods The clinical data of 314 patients undergoing laparoscopic radical hysterectomy from January 2013 to December 2015, the complication rate was observed, and the inlfuencing factors were analyzed by the method of multiple factor analysis. Result The number of intraoperative complications were 20 cases, accounting for 6.37%, the number of postoperative complications were 80 cases, accounting for 25.48%. Intraoperative complications influence factors including FIGO, surgery time, doctors surgery experience [OR

Research on the application of holistic nursing intervention in perioperative nursing for patients underwent radical hysterectomy under laparoscopy / 中国医学装备

Objective:To investigate the effect of holistic nursing intervention in perioperative nursing for patients underwent radical hysterectomy under laparoscopy. Methods: 80patients with cervical cancer were divided into observation group (40cases) and control group (40cases), and patients of control group received routine nursing modein perioperative period while patients of observation group received holistic nursing mode in the same stage. The complication of the two groups were compared and analyzed, and the satisfaction degree for nursing mode was investigated.Results: Under the intervention of holistic nursing, the number of complication of observation group was significantly lower than that of control group (x2=8.205,P<0.05). And the satisfaction degree for nursing of observation group was significantly higher than that control group(x2=5.000,P<0.05).Conclusion: The holistic nursing intervention in perioperative nursing for patients underwent radical hysterectomy under laparoscopy can significantly improve the life quality of patients, and reduce the occurrence of complication, and enhance the satisfaction degree of patients for nursing.

Observation of Dezocine Combined with Parecoxib on Prevention of Emergence Pain and Agitation in Pa-tients Undergoing Radical Hysterectomy / 中国药师

Objective:To compare the preventive effects of dezocine or parecoxib used alone or combination on emergence pain and agitation in the patients undergoing radical hysterectomy. Methods: Sixty ASA Ⅰ~Ⅱ patients undergoing radical hysterectomy were randomly divided into three groups. At the time of sewing incision, the dezocine group (group D, n=20) received dezocine in-travenous injection at the dosage of 0. 1 mg·kg-1, the parecoxib group (group P, n=20) received parecoxib intravenous injection at the dosage of 0.8 mg·kg-1, and the combination group (group DP, n=20) received 0.1 mg·kg-1dezocine and 0.8 mg·kg-1 parecoxib. When the operation was finished, the patients were transferred to the recovery room with endotracheal tubes, and recovered and extubated without the administration of reversal agents. Visual analogue scale ( VAS) for pain and Aono' s four-point scale for e-mergence agitation ( EA) were measured. The recovery time, extubation time, VAS, degree of EA and side effects such as nausea, vomiting, respiratory depression and hypersomnia during the emergence were also evaluated and recorded. Results:There were no sig-nificant differences in recovery time and extubation time among the three groups (P >0. 05). The VAS score and degree of EA in group DP were lower than that in group D (4. 65 ± 1. 69) and group P (5. 95 ± 1. 82) (P0. 05), and no side effects such as nausea, vomiting, respiratory depression and hypersomnia were detected during the emergence. Conclusion:Intravenous injection of 0. 1 mg·kg-1 dezocine combined with 0. 8 mg·kg-1 parecoxib at the time of sewing incision shows effective analgesia and emergence agitation reduction without obvious complications in the patients undergoing radical hysterecto-my.

Laparoendoscopic single-site radical hysterectomy for early stage cervical cancer

Technical developments have made laparoendoscopic single-site (LESS) surgery increasingly more feasible for treating gynecological conditions, including cancer. However, complex surgeries such as radical hysterectomy have rarely been performed with single-port access because of technical difficulties. The majority of the difficulties are due to the inefficient retraction of tissue during dissection. Here, we report a detailed description of LESS radical hysterectomy plus pelvic lymph node dissection that was successfully performed in two patients with stage IB1 cervical cancer. We used our expertise with LESS to perform space development as much as possible before the ligaments were resected. The oncologic clearance was comparable to that of conventional laparoscopic radical hysterectomy.