Study on the complications of radical vaginal hysterectomy for locally bulky cervical cancer patients / 中国医师杂志

Objective To analyze the complications of radical vaginal hysterectomy in patients with locally bulky cervical cancer.Methods All 258 patients of early cervical cancer (stage Ⅰ A2-Ⅱ A) selected in our hospital during the period of June 2011 to June 2016 undergoing radical vaginal hysterectomy and laparoscopic pelvic lymph node dissection were analyzed.All cases were divided into observation (locally bulky) and control (conventional) groups.Comparison analysis was performed for complications of the two groups and the influence of neoadjuvant chemotherapy on the complications of local bulky patients.Results The incidence of complications in the observation group was 26 cases (27.9％),higher than that in the control group of 28 cases (17.0％),the difference was statistically significant (P ＜ 0.05).The incidence of bladder injury (5 cases vs 2 cases) in observation group was significantly higher than that in control group (P ＜ 0.05).For patients with locally bulky early cervical cancer,the incidence rate of complications of the neoadjuvant chemotherapy group (15.8％) was significantly lower than the simple operation group (36.4％) (P ＜ 0.05).The incidence rate of ureteral injury in neoadjuvant chemotherapy group (0 cases vs 6 cases) was significantly lower than that in simple operation group (P ＜ 0.05).Conclusions Early cervical cancer patients with locally bulky (stage Ⅰ B2/ 1Ⅱ A2) had higher incidence of complications of radical vaginal hysterectomy,and neoadjuvant chemotherapy can reduce the incidence of surgical complications.

The clinical effect of Cold-Knife Conization in patients with early cervical cancer and its influence in the pregnancy outcome / 中国医师杂志

Objective To study the clinical effect of Cold-Knife Conization (CKC) in patients with early cervical cancer and its influence in the pregnancy outcome.Methods 40 early cervical cancer patients of adopting the CKC from January 2010 to September 2012 in our Department were selected as observation group.40 early cervical cancer patients without history of cervical conization were selected as control group.All patients were followed up for 8 to 36 months.Tumor recurrence,pregnancy and maternity history and pregnancy outcomes were recorded and compared between groups.Results In the observation group,32 cases were pregnant (the success rate of pregnancy was 80.0％),of which 4 cases were aborted and the delivery rate was 87.5％.In the control group,39 cases were pregnant(the success rate of pregnancy was 97.5％),no abortion was found,and the delivery rate was 100.0％.The pregnancy rate and delivery rate in the observation group were lower than those in the control group (P ＜ 0.05).There was no significant difference in delivery mode between the two groups (P ＞ 0.05).The observation group had 8 cases (28.6％) premature delivery,9 cases (32.1％) neonatal asphyxia,6 cases (21.4％) premature rupture of membranes,and the average weight of neonates was (2 842.17 ±48.99)g.The control group had 3 cases (7.7％) premature delivery,1 case (2.6％) neonatal asphyxia,2 cases (5.1％) premature rupture of membranes,and the average weight of neonates was (3 243.81 ±51.02)g.The perinatal premature birth rate,neonatal asphyxia rate and premature rupture rate of membranes in the observation group were higher than those in the control group,and the average weight of newborns was lower than that in the control group,with statistically significant difference (P ＜ 0.05).During the follow-up period,the recurrence rate of the observation group was lower than that ofthe control group [2.5％ (1/40) vs 17.5％ (7/40)],with statistical significant significance (P ＜ 0.05).Conclusions Although cold knife conization can reduce the recurrence rate of early cervical cancer patients,the fertility and pregnancy outcomes of patients after operation is greatly affected.Careful selection should be made in clinical treatment according to the actual situation.

Clinical effect of laparoscopy in the modified nerve palne-sparing radical hysterectomy of early stage cervical cancer / 中国医师杂志

Objective To evaluate the clinical effect of laparoscopy in the modified nerve painesparing radical hysterectomy (NPSRH) of early stage cervical cancer.Methods From January 2014 to December 2015 in our hospital,38 patients with early cervical caucer were enrolled and randomly divided into NPSRH group and laparoscopic radical hysterectomy (LRH) group in the study.The surgery general situations of two groups were compared,and postoperative intestinal and bladder function of these patientswere also assessed.Results All of 38 patients were successfully completed the operation,without significant intraoperative or postoperative complications.There were no significant differences in the bleeding volume,pelvic lymph dissection number,cut length of main ligament and sacral ligament,cut length of anterior vaginal wall,and posterior vaginal wall between two groups (P ＞ 0.05).The mean operation time in NPSRH group was longer than in LRH group,but the duration of postoperative hospital stay was shorter than the latter (P ＜ 0.01).Compared to control group,the catheter retention time,residual urine volume,maximal micturition volume,and Qmax in the NPSRH group recovered better,and with lower rate of nocturia mnd dysuria (P ＜ 0.05).The exhaust time and anal defecation time in the NPSRH group were significantly shorter than the LRH group,and lower rate of constipation additionally (P ＜ 0.05).Conclusions The laparoscopy in the modified nerve paine-sparing radical hysterectomy is a safe and effective measurement for the treatment of early-stage cervical cancer patients.It can significantly reduce the duration of postoperative hospital stay,promote the functional recovery of bladder and rectum,and improve the patients'postoperative quality of life.

Quality of marriage and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension / 中国医师杂志

Objective To investigate the quality of marriage and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension.Methods Case-control and questionnairebased methods were used in this study.Forty patients of early-stage (Ⅰ b 1 ～ Ⅰ b2) cervical cancer who had undergone vaginal extension following classic radical hysterectomy were included in the observation group,while 40 patients with matching factors and radical hysterectomy only during the same period were included in the control group.The quality of marriage and sexual function were compared with OLSON marriage prolapse and incontinence sexual function questionnaire Shon Fonn (PISQ-12).Results The operation time and postoperative vaginal length in the observation group were higher than those in the control group (P ＜ 0.05 or P ＜ 0.01).The emotional,physical,and total scores during postoperation were lower than those during preoperation (P ＜ 0.01).The emotional,physical,and total scores in the control group were lower than those in the observation group (P ＜ 0.01).The marital satisfaction,husband and wife communication,conflict resolution methods,extracurricular activities and sex scores in the observation group were higher than those in the control group (P ＜ 0.05 or P ＜ 0.01).Conclusions Patients with peritoneovaginoplasty following radical hysterectomy had much longer vagina and less self-perceived short vagina.Vaginal extension following radical hysterectomy does not worsen the pelvic floor symptoms.

The clinical value of para-aortic lymphadenectomy in patients with early stage cervical carcinoma / 中国医师杂志

ObjectiveTo investigate the clinical value of routine para - aortic lymphadenectomy in patients with stage Ⅰ B1 and Ⅱ A2 cervical cancers treated by surgical intent.Methods240 patients with stage Ⅰ B1 and Ⅱ A2 squamous cervical cancer were randomly divided into tow groups( group A and B).120 patients (group A) underwent radical hysterectomy with systematic pelvic lymphadenectomy and paraaortic lymphadenectomy.Other 120 patients (group B) underwent radical hysterectomy with systematic pelvic lymphadenectomy,additional para-aortic lymphadenectomy were carried out when para-aortic lymph nodes were identified as suspicious by visualization and palpation.The operation time,amount of surgical bleeding,length of stay,complications,and metastasis rates of pelvic lymph node,metastasis rates of common iliac lymph node and metastasis rates of para-aortic lymph node were analyzed between two groups.ResultsThe clinical characteristics of the patients had no statistically significant difference between the two groups.The length of stay and the complications of group A were significantly higher than group B ( P ＜0.05 ).During the 240 patients,the metastasis rates of pelvic lymph node,common iliac lymph node and para-aortic lymph node were 27.9％,10.8％ and 5.4％.The metastasis rate of para-aortic lymph node in group A was statistically higher than that in group B( 8.3％ vs 2.5％,P ＜0.05),whereas there had no significant difference of the metastasis rates of pelvic lymph node and common iliac lymph node between the two groups.ConclusionsRoutine para-aortic lymphadenectomy can be helpful to accurately predict the status of the para-aortic lymph node in patients with stage Ⅰ B1 and Ⅱ A2 cervical cancer,but the length of stay and the complications of operation will increase.

Clinical study of laparoscopic pelvic lymphadenectomy assisted radical vaginal hysterectomy (LARVH) in the treatment of cervical cancer / 中国医师杂志

Objective To discuss clinical effect and feasibility of laparoscopic pelvic lymphadendenectomy assisted radical vaginal hysterectomy (LARVH) in the treatment of cervical cancer. Methods Laparoscopic pelvic lymphadendenectomy assisted radical vaginal hysteretomy was performed in 38 patients with cervical cancer. The operative quality and postoperative recovery effects were analyzed. Results All 38 patients were successfully performed with LARVH and no complications. The radical vaginal hysteretomy were performed in all of patients, 21.4±2.2 pelvic lymph nodes were removed. The average duration of surgery was (240±25.6) min and the average hemorrhage was (340±40.2) ml. There were 7 patients who needed blood transfusion during operation. After operation, the mean time for passage of gas by anus was (2±0.26) days, and the mean recovery time of bladder function was (10.5±1.3) days. Patients were discharged after (9.2±1.1) days on average. 38 patients had no complication. Conclusions For the treatment of uterine neoplasm, LARVH decreased operative damage with more short recovery time, same operative extent as laparotomy. It is an ideal way to treat uterine neoplasm currently.