Radical hysterectomy and pelvic lymph node debridement

Cervical cancer is the most common gynecological malignant tumor, which seriously endangers the health of many women. Comprehensive hysterectomy plus pelvic lymph node clearance is the classic method of surgical treatment of cervical cancer. However, the traditional open surgery process is complicated, the surgical trauma is large, and there are many complications during and after the operation. With the gradual improvement of laparoscopic operation technology, comprehensive uterine uterus resection and pelvic lymph node cleaning under laparoscopic surgery have gradually been accepted by obstetricians and gynecologists and patients in my country.

Complete hysterectomy is the surgical treatment for cervical cancer. It is a basic surgery for the treatment of cervical cancer. The focus is on completely removing the local lymph nodes, as well as performing a complete hysterectomy, removing the parauterine, paracervical, paravaginal and proximal vaginal tissues.

Pelvic lymph node resection is an important part of surgical treatment for patients with gynecological malignant tumors, and its results are related to the patient's tumor stage, prognosis, and choice of postoperative treatment. Surgical treatments for pelvic lymph node removal include retroperitoneal lymph node removal and intra-abdominal lymph node removal. The former has relatively more advantages and is more widely used in clinical medicine. Pelvic lymph node removal includes the removal of lymph nodes in the upper and lower iliac common, internal and external iliac, omental bursa, deep inguinal and presacral areas.

Common complications of laparoscopic hysterectomy and pelvic lymph node dissection include intraoperative visceral organ damage, vascular damage and bleeding, and postoperative lymphocystic cyst formation. In this study, 1 case of urethral tube injury occurred during the laparoscopic surgery group, and 2 cases had vaginal urine discharge 10-14 days after the surgery. Intravenous pyelography showed urethral tube vaginal fistula, and the patients were transferred to the urology department of a general hospital for treatment.

Urethral tube injuries are divided into direct injuries and indirect injuries. Direct injuries are caused by injuries immediately during surgery, including breakage, accidental puncture, electric burns, etc. Intermittent injuries are urethral tube fistulas, which are often caused by the wide coverage of the urethral tube during surgery, damaging the urethral sheath, affecting the blood supply of part of the urethral tube, causing delayed ischemia and necrosis, resulting in urine leakage, which often occurs 10-20 days after surgery and is a relatively serious complication.

Therefore, it is necessary to understand the anatomy and adjacent relationships of the urethra. Large-scale electrocoagulation should be avoided as much as possible when separating and activating blood circulation during surgery. Ultrasound knives or scissors should be used as much as possible to separate adjacent urethral tissues. If there is heavy bleeding during surgery, it should be handled calmly, and open surgery should be performed immediately when necessary to avoid blindly pursuing minimally invasive surgery and causing serious consequences. Before the operation, the difficulty of the operation should be fully estimated according to the patient's actual condition, and the ureteral stent should be inserted before the operation if necessary.

The short-term and long-term effects of laparoscopic hysterectomy and pelvic lymph node dissection in the treatment of early cervical cancer are comparable to those of open surgery, and it has the advantages of less bleeding, less trauma, and faster recovery. It can be used as one of the options for surgical treatment of early cervical cancer.