\n\n
\n\n但是,在做宫颈癌根治性手术的时候,我们仅仅切除宫颈是不够的,因为宫颈癌细胞会向周围组织浸润,包括阴道、两侧的宫旁组织等,因此必须将子宫连同一部分宫旁组织和阴道一起切除才行。举个例子,就好比拔萝卜,如果要连根拔起,必须把周围的土壤也一起挖掉。那么,明白了这些道理,我们再来理解这几种手术方式就比较容易了。
\n\n首先来说广泛性子宫切除术,这种手术方式最早可以追溯到一百多年前,它是宫颈癌最经典,也是应用最为广泛的手术方式,适合大多数早期的宫颈癌。广泛性子宫切除术需要切除整个子宫、子宫旁 3 厘米宽的韧带、3 厘米长的阴道,绝经以后的患者还建议切除双侧卵巢和输卵管。另外,盆腔淋巴结的彻底清扫也非常重要,有时候甚至还需要切除腹主动脉旁的淋巴结。
\n\n这种手术在妇科恶性肿瘤中属于比较大的手术,通常需要进行 2~4 个小时。手术的风险也是比较高,手术过程中可能发生大出血、膀胱和输尿管的损伤等情况。因此,广泛性子宫切除术需要医生具备较高的操作技巧和熟知解剖的结构。
\n\n次广泛性子宫切除术是相对于广泛性子宫切除术而言的,从切除的范围来说其实差别并不大,区别就是子宫旁的韧带和阴道都是切 2 厘米,通常也需要做盆腔淋巴结清扫或者至少要做活检。这种手术相对于广泛性子宫切除术来说,手术时间少、创伤小、恢复快,适合最早期的宫颈癌。
\n\n保留神经的广泛性子宫切除术是在广泛性子宫切除术的基础上进行了改进。因为广泛性子宫切除术有一个很大的弊端——就是盆腔神经的损伤,会导致膀胱功能障碍、直肠功能紊乱、性功能受损等等。特别是膀胱功能障碍,发生率高达 70%~85%,导致许多患者出现术后排尿困难,不得不长期放置导尿管,甚至有时候要放好几个月。如此一来,不仅影响日常生活,还可能引起尿路感染等问题。
\n\n为了减少这种情况的发生,医生们开始研究如何在宫颈癌手术中保留这些神经。于是,保留神经的广泛性子宫切除术便应运而生。这种手术方式最早是由日本学者发明的,所以又称为“东京”术式。
\n\n保留神经的广泛性子宫切除术需要医生对解剖结构非常熟悉,同时要小心仔细,才能避免误伤。因为盆腔的内脏神经非常细,而且隐藏在子宫旁的组织里,很难被发现。但随着腹腔镜手术的开展,通过腹腔镜的放大作用,保留神经的手术成功率有了很大提高。经过保留神经的手术后,大部分患者的症状明显改善,无论是留置导尿管的时间还是尿路感染的发生都会明显地减少。
\n\n通过上面,我们发现以上三种手术的共同点在于都需要切除子宫,那么对于年轻未生育的女性来说,有没有办法可以保留生育功能呢?
\n\n经过专家们多年的努力和探索,终于研究出了这种手术方式,即根治性宫颈切除术。特点在于保留子宫体,只切除宫颈以及宫颈旁的一些韧带和部分阴道,然后将子宫体和阴道重新吻合。手术后除了没有宫颈以外,其他都和以前一样。
\n\n由于保留了子宫体,患者仍然具有生育功能。当然,由于手术以后盆腔粘连影响输卵管的拾卵、失去宫颈后导致流产几率增加等等情况,最终能否怀孕成功还取决于其他很多因素,有报道称怀孕成功率在 30% 左右。
\n\n需要注意的是,并非所有的患者都适合做这个手术,需要满足以下条件:
\n\n所以,不能满足上述条件的患者,还是接受广泛性子宫切除术更加安全。
\n\n 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