摘要
盆腔植物神经丛由腹下神经和盆腔内脏神经组成。妇科肿瘤的盆腔手术经常遇切除主骶韧带或直肠系膜时损伤盆腔神经丛，而导致长时间保留尿管。保留盆腔植物神经（PANS）有利于尽快恢复膀胱排尿功能，子宫内膜癌行次广泛子宫切除者，Ⅰ型PANS多数患者可行，即完全保留盆腔神经丛，3天左右拔除尿管；一般意义上的子宫颈癌根治术，行Ⅱ型保留神经方式，即部分病例中保留大部分盆丛神经，7天左右拔除尿管；超根治性子宫切除手术，采用Ⅲ型PANS，即部分病例、大部分保留健侧神经，达到2～3周拔除尿管的目的。而在全阴道切除手术、Hartman手术、Dixon手术以及后盆腔脏器清除术中，部分病例可以选择Ⅱ型或Ⅲ型的神经保留手术。
Bladder function is controlled by the hypogastric nerves （sympathetic） and pelvic splanchnic nerves （parasympathetic） , and these two nerve fibers intermingle to form the pelvic plexus. Pelvic surgery was one of the important modalities being used in pelvis-gynecology, but it was commonly found that the modality could cause bladder dysfunction because of its damage to the pelvic plexus. Pelvis-gynecologic surgeries like Pive Ⅱ -Ⅳ radical hysterectomy （ RH）, total vagineetomy, Hartman, Dixon, and posterior pelvic exenteration are among the most important causes of urinary dysfunction. Recently, urinary dysfunction has become the major issue for patients undergoing pelvic surgery in terms of quality-of-life. Pelvic autonomic nerve-sparing （PANS） protects postsurgical bladder function in radical RH and other pelvic surgery. The review tried to discuss different types of PANS being used in variety of pelvis-gynecologic surgery. Type Ⅰ PANS can be performed in Piver Ⅱ RH in patients with endometrioid cancer, and urinary catheter will be removed 3 days after operation. Type Ⅱ PANS is used in Piver Ⅲ RH, and the catheter can be successfully removed 7 days after surgery. Sometimes, type Ⅲ PANS is administered in one-side tumor-free cardinal ligament resection, and the patients will retain their catheter for 3 weeks postoperatively. Type Ⅱ or type Ⅲ PANS may be used in total vaginectomy, Hartman, Dixon, and posterior pelvic exenteration.
出处
《中国癌症杂志》
CAS
CSCD
2006年第11期907-910,共4页
China Oncology
关键词
盆腔神经丛
膀胱功能
盆腔手术
pelvic autonomic nerve-sparing
bladder function
pelvic surgery
