RESUMO
OBJECTIVE: To explore the surgical extent and to improve the surgical techniques of the Piver class III hysterectomy on invasive 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 Ib and IIa 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 Piver 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 are 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.
