中国现代手术学杂志2025，Vol.29Issue(5)：372-379,8.DOI:10.16260/j.cnki.1009-2188.2025.05.004
腹腔镜下骶前神经精准解剖与保护对广泛性子宫切除术后膀胱功能保留的意义
The significance of precise anatomical identification and preservation of the presacral nerve in laparo-scopic radical hysterectomy for postoperative bladder function preservation
摘要
Abstract
Objective To investigate the feasibility,safety,and short-term clinical efficacy of precise anatomical identification and preservation of the presacral nerve(superior hypogastric plexus)during laparo-scopic radical hysterectomy(LRH)for early-stage cervical cancer patients.Methods A prospective cohort study was conducted,enrolling 142 patients scheduled for surgery between January 2023 and June 2025.Pa-tients were divided into a study group(n=72,undergoing conventional LRH combined with precise presacral nerve preservation)and a control group(n=70,undergoing conventional LRH only).Perioperative indicators,postoperative bladder function recovery,3-month urodynamic parameters,pelvic floor function,and quality of life scores were compared between the two groups.Results Baseline characteristics were comparable be-tween the two groups(P>0.05).The success rate of presacral nerve identification and preservation in the study group was 95.8%(69/72).Operative time was longer[(218.6±35.4)min vs.(205.3±31.2)min,P<0.05],and the overall complication rate was less in the study group,but there were no significant differences in intrao-perative blood loss,number of lymph nodes dissected,or grade Ⅲ+complications.Postoperative indwelling catheterization time was significantly shorter in the study group[(5.2±1.8)d vs.(11.6±3.5)d,P<0.001].The first catheter removal success rate was higher in the study group(88.9%vs.21.4%,P<0.001),and the rate of urinary retention requiring recatheterization was 0,which was significantly lower than 24.3%(17/70)in the control group(P<0.001).At 3 months postoperatively,the study group had a higher maximum urinary flow rate[(20.1±3.9)mL/s vs.(15.3±4.7)mL/s,P<0.001]and a lower incidence of overactive bladder(5.6%vs.31.4%,P<0.001).Both the total PFDI-20 score and the SF-12 physical health score were signif-icantly better in the study group(all P<0.001).Bladder ultrasound at 6 months postoperatively showed that the study group had thinner detrusor muscle thickness and lower post-void residual urine volume(all P<0.001),and these two parameters were positively correlated(r=0.712,P<0.001).Conclusion In laparoscopic radical hysterectomy,the technique of precise presacral nerve preservation based on meticulous anatomical dissection is safe and feasible.It can significantly promote postoperative bladder function recovery,reduce the risk of urinary retention,and improve patients'short-term pelvic floor function and quality of life.关键词
宫颈肿瘤/广泛性子宫切除术/腹腔镜检查/骶前神经/神经保护/解剖学Key words
uterine cervical neoplasms/radical hysterectomy/laparoscopy/presacral nerve/nerve preservation/anatomy引用本文复制引用
张琦,王鑫,徐智阳,张潍,杨红..腹腔镜下骶前神经精准解剖与保护对广泛性子宫切除术后膀胱功能保留的意义[J].中国现代手术学杂志,2025,29(5):372-379,8.基金项目
国家自然科学基金面上项目(82172993) （82172993）
