[1]闵捷 马嘉兴 张志强 耿浩 张志辉 于德新**.保留阴道前壁和神经的女性根治性膀胱切除术(附13例报告)[J].中国微创外科杂志,2021,01(7):638-642.
　Min Jie,Ma Jiaxing,Zhang Zhiqiang,et al.Anterior Vaginal Wall and Nervesparing Laparoscopic Radical Cystectomy in Female Patients: Report of 13 Cases[J].Chinese Journal of Minimally Invasive Surgery,2021,01(7):638-642.
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保留阴道前壁和神经的女性根治性膀胱切除术(附13例报告)()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年7期
页码:
638-642
栏目:
短篇临床
出版日期:
2021-07-25

文章信息/Info

Title:
Anterior Vaginal Wall and Nervesparing Laparoscopic Radical Cystectomy in Female Patients: Report of 13 Cases
作者:
闵捷 马嘉兴 张志强 耿浩 张志辉 于德新**
（安徽医科大学第二附属医院泌尿外科，合肥230601）
Author(s):
Min Jie;  Ma Jiaxing;  Zhang Zhiqiang;  et al.
Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230601, China
关键词:
根治性膀胱切除术; 女性; 性功能; 保留阴道前壁; 保留神经
Keywords:
Radical cystectomy; Female; Sexual function; Anterior vaginal wallsparing; Nervesparing
文献标志码:
A
摘要:
目的探讨保留阴道前壁和神经的女性根治性膀胱切除术的价值。 方法2018年1月～2019年12月我科对13例膀胱癌施行保留阴道前壁和神经的根治性膀胱切除术联合尿流改道术，术中先进行扩大淋巴结清扫术，注重对腹下神经和盆丛的保护。自阴道底部横断阴道后壁和前壁，在阴道前壁10～2点范围内无神经血管层面靠近膀胱壁游离并离断膀胱侧血管蒂；在尿道近端游离时，远离膀胱颈并避免进入盆内筋膜，从而保护阴道侧方的自主神经纤维和盆底传入的会阴神经分支。术后采用女性性功能指数（Female Sexual Functions Index，FSFI）评估性功能恢复情况。结果术后病理示阴道及尿道切缘均为阴性。1例盆腔淋巴结阳性，余12例在平均13.1月（6~25个月）的随访中无局部复发和远处转移。术后3个月FSFI评分较术前显著下降［（6.0±3.8）分 vs.（19.4±6.3）分，P=0.000］，术后6个月评分较术后3个月显著恢复［（14.1±6.7）分vs.（6.0±3.8）分，P=0.001］，其中FSFI子项 “润滑度”和“性交痛”评分对于术后性功能评分恢复的贡献最大。结论严格选择病例，保留阴道前壁和神经的根治性膀胱切除术可以使患者获得更好的术后生活质量。
Abstract:
ObjectiveTo discuss and evaluate the value of anterior vaginal wall and nervesparing laparoscopic radical cystectomy in female patients.MethodsFrom January 2018 to December 2019, 13 patients underwent anterior vaginal wall and nervesparing laparoscopic radical cystectomy and appropriate urinary diversion. In the surgical procedure, an elaborate “extended” lymphadenectomy was applied, with special care not to damage the hypogastric nerves and pelvic plexus. In the cystectomy, the peritoneum was incised below the vaginal fundus, and the dissection was proceeded at the specific position (between 10 o’clock and 2 o’clock direction) of anterior vaginal wall with the preservation of the paravaginal autonomic nerve. When reaching the trigone and proximal urethra, attentions were emphasized as to prevent the damage of the perineal nerves. The sexual function was evaluated by using the Female Sexual Functions Index (FSFI).ResultsThe histopathology showed no positive surgical margins of vagina and urethra. One patient was reported positive pelvic lymph nodes, and the other 12 patients remained free from disease without local recurrence and metastasis in a mean followup of 13.1 months(range,6-25 months). The FSFI was evaluated postoperatively, which showed an absolute “collapse” in the third month during the followup ［(6.0±3.8) points vs. (194±6.3) points，P=0.000］, and a significant recovery at the sixth month ［(141±6.7) points vs. (6.0±3.8) points, P=0.001］. The two domains of FSFI “Lubrication” and “Intercourse Pain” contributed most in the sexual function improvement.ConclusionWith careful selection for voluntary cases, anterior vaginal wall and nervesparing radical cystectomy obtains a better quality of life in female patients.

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备注/Memo

备注/Memo:
基金项目：安徽医科大学2020年度校科研基金项目（2020xkj194）；安徽医科大学第二附属医院博士科研基金（2018BSJJ014）；安徽医科大学第二附属医院首批临床研究培育计划项目（2020LCYB20）**通讯作者，Email:yudx_urology@126.com
更新日期/Last Update: 2021-10-11