ERKEN EVRE SERVİKS KANSERLİ LAPARASKOPİK SİNİR KORUYUCU RADİKAL HİSTEREKTOMİ YAPILAN 13 OLGUDA Kİ KLİNİK İLK DENEYİMİMİZ

Yıl 2019, Cilt: 4 Sayı: 3, 28 - 36, 31.12.2019

Ünal Turkay Ahmet Kale Hasan Terzi Mehmet Salıcı Bahar Sarıibrahim Astepe

Öz

Erken evre serviks kanseri (EvreIA1-Evre IIA) tedavisinde geleneksel radikal histerektomi yapılan hastalarda postoperatif dönemde pelvik taban disfonksiyonu görülmektedir. Bu çalışmada Kocaeli Derince Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde Ocak 2015-Ocak 2018 yılları arasında Erken evre serviks tanısı alan laparaskopik sinir koruyucu radikal histerektomi (LSKRH) yapılan 13 olgunun klinik ilk deneyimini, operasyon sonrası kontrollerinde Urogenital Distress Inventory (UDİ 6) anket testi ve hasta memnuniyet skoru (HMS) sonuçlarını değerlendirmek amaçlandı. Çalışma kapsamında 13 hastanın dosyası retrospektif olarak incelendi.Hastalarımızın yaş ortalaması 52,7±11,00 idi ve %61,53’ü postmenapozal dönemde idi. Hastaların operasyon süresi ortalama 223,46±51,85 dk, hastanede kalış süresi ortalama 8±3,05 gün ve sonda çekilme süresi ortalama 4,76± 5,19 gün olarak tespit edildi. Postoperatif rezidü ortalaması 38,84±11,39 ml olarak tespit edildi. Komplikasyon olarak 1 (%7,6) hastada üreter yaralanması ve 1 (%7,6) hastada vena iliaca externa yaralanması gerçekleşti. Postoperatif erken dönemde 1 (%7,6) hastada ileus, 1 (%7,6) hastada idrar yapamama ve 1 (%7,6) hastada da pulmoner emboli görüldü. Postoperatif 6.ay kontrollerinde UDİ-6 anket testi iritatif bulgular ortalama 1,76±2,27 ; stres bulguları ortalama 1,23±1,87, obstrüktif bulgular ortalama 1,23±1,09 ve HMS ortalama 8,84±1,46 olarak tespit edildi. LSKRH pelvik taban disfonksiyonu önleme açısından geleneksel radikal histerektomiden daha etkili olabilir.

Anahtar Kelimeler

Mesane fonksiyonu, servikal kanser, sinir koruyucu, laparaskopik radikal histerektomi

Kaynakça

• 1 Vaccarella, S., Lortet-Tieulent, J., Plummer, M., Franceschi, S., & Bray, F. (2013). Worldwide trends in cervical cancer incidence: impact of screening against changes in disease risk factors. European journal of cancer, 49(15), 3262-3273. 2 Pomel, C., Atallah, D., Le Bouedec, G., Rouzier, R., Morice, P., Castaigne, D.et al.(2003). Laparoscopic radical hysterectomy for invasive cervical cancer: 8-year experience of a pilot study. Gynecologic oncology, 91(3), 534-539. 3 Butler-Manuel SA, Buttery LD, A’Hern RP, Polak JM, Barton DP. Pelvic nevre plexus trauma at radical hysterectomy and simple hysterectomy: the nevre content of the uterine supporting ligaments. Cancer 2000;89(4): 834–41. 4 Fujii, S., Takakura, K., Matsumura, N., Higuchi, T., Yura, S., Mandai, M., et al. Anatomic identification and functional outcomes of the nevre sparing Okabayashi radical hysterectomy. Gynecol Oncol. 2007;107:4e13. 5 Van den Tillaart, S. A., Kenter, G. G., Peters, A. A., Dekker, F. W., Gaarenstroom, K. N., Fleuren, G. J.,et al. Nerve-sparing radical hysterectomy: local recurrence rate, feasibility, and safety in cervical cancer patients stage IA to IIA. Int J Gynecol Cancer 2009;19:39–45. 6 Espino-Strebel E, Luna J, Domingo E. A comparison of the feasibility and safety of nerve-sparing radical hysterectomy with the conventional radical hysterectomy. Int J GynecolCancer 2010;20(7):1274–83. 7 Glahn BE. The neurogenic factor in vesical dysfunction following radical hysterectomy for carcinoma of the cervix. Scand J UrolNephrol. 1970;4:107–116. 8 Seski JC, Diokno AC. Bladder dysfunction after radical abdominal hysterectomy. Am J Obstet Gynecol. 1977;128:643–651. 9 Fishman IJ, Shabsigh R, Kaplan AL. Lower urinary tract dysfunction after radical hysterectomy for carcinoma of cervix. Urology. 1986;28:462–468. ] 10 Juliane K , Tilemachos K, Stefanie A, Kaven B, Bernhard S. Short and long-term urodynamic and quality of life assessment after nerve sparing radical hysterectomy: a prospective pilot study. European Journal of Obstetrics & Gynecology and Reproductive Biology 201 (2016) 131–134132 11 Cam, C., Sakalli, M., Ay, P., Cam, M., & Karateke, A.: Validation of the short forms of the incontinence impact questionnaire (IIQ-7) and the urogenital distress inventory (UDI-6) in a Turkish population. Neurourol Urodyn 2007; 26: 129. 12 Selcuk S , Cetin C, Mehmet RA , Mehmet K , Arzu A , Muzaffer SC ve ark.. Effect of simple and radical hysterectomy on quality of life – analysis of all aspects of pelvic floor dysfunction. European Journal of Obstetrics & Gynecology and Reproductive Biology 198 (2016) 84–88 13 Yabuki Y, Sasaki H, Hatakeyama N, Murakami G. Discrepancies between classic anatomy and modern gynecologic surgery on pelvic connective tissue structure: harmonization of those concepts by collaborative cadaver dissection. Am J Obstet Gynecol 2005;193:7–15. 14 Katahira, A., Niikura, H., Kaiho, Y., Nakagawa, H., Kurokawa, K., Arai, Y. et al. Intraoperative electrical stimulation of the pelvic splanchnic nevres during nerve-sparing radical hysterectomy. Gynecol Oncol2005;98:432–6. 15 Katahira, A., Niikura, H., Ito, K., Takano, T., Nagase, S., Murakami, G.,, et al. Vesicouterine ligament contains abundant Autonomic nevre ganglion cells: the distribution in histology concerning nerve-sparing Radical hysterectomy. Int J GynecolCancer 2008, 18, 193–198 16 Hazewinkel, M. H., Sprangers, M. A. G., Van der Velden, J., Van der Vaart, C. H., Stalpers, L. J. A., Burger, M. P. M., et al.Long-term cervical cancer survivors suffer from pelvic flor symptoms: a cross-sectional matched cohort study. Gynecol Oncol. 2010;117:281Y286 17 Tseng, C.-J., Shen, H.-P., Lin, Y.-H., Lee, C.-Y., & Wei-Cheng Chiu, W. (2012). A prospective study of nerve-sparing radical hysterectomy for uterine cervical carcinoma in Taiwan. Taiwanese Journal of Obstetrics and Gynecology, 51(1), 55–59. 18 Sung Uk, L., Young Ae, K., Young-Ho, Y., Yeon-Joo, K., Myong Cheol, L., Sang-Yoon, P.,et al. (2017). General health status of long-term cervical cancer survivors after radiotherapy. Strahlentherapie Und Onkologie, 193(7), 543–551. doi:10.1007/s00066-017-1143-8 19 Lin, L. Y., Wu, J. H., Yang, C. W., Sheu, B. C., & Lin, H. H.. Impact of radical hysterectomy for cervical cancer on urodynamic findings. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15:418–421. 20 Dursun P, Ayhan A, Kuscu E. Nerve-sparing radical hysterectomy for cervical carcinoma. Crit Rev Oncol Hematol 2009;70:195-205. 21 Chen L, Zhang WN, Zhang SM, Yang ZH, Zhang P. Effect of Laparoscopic Nerve-sparing Radical Hysterectomy on Bladder Function, Intestinal Function Recovery and Quality of Sexual Life in Patients with Cervical Carcinoma. Asian Pac J Cancer Prev 2014;15:10971-5. 22 Nam JH, Park JY, Kim DY, Kim JH, Kim YM, Kim YT. Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study. Ann Oncol. 2012;23:903-11. 23 Hee Seung Kim, Miseon Kim, Yanlin Luo,Maria Lee MD, Yong Sang Song. Favorable factors for preserving bladder function after nerve-sparing radical hysterectomy: A protocol-based validation study. J Surg Oncol. 2017;9999:1–8. 24 C.B.M. Kruijdenberg, L.C.G. van den Einden, J.C.M. Hendriks, P.L.M. Zusterzeel, R.L.M. Bekkers. Robot-assisted versus total laparoscopic radical hysterectomy in early cervical cancer, a review. Gynecologic Oncology 120 (2011) 334–339.