Cervical cancer is the most common malignant tumor of the female reproductive organs, and its incidence has tended to be younger in recent years. Endocervical cancer is one of the three major malignant tumors of the female reproductive tract, and its incidence has been on the rise worldwide in recent years. The main treatment for early cervical cancer and early endometrial cancer is extensive hysterectomy plus pelvic lymph node dissection.
This procedure has a wide resection area, high clearance rate and good efficacy. Due to the extensive resection, various complications are likely to occur, and bladder dysfunction of different degrees is the most common complication of this surgery, mainly manifested as urinary retention.
Urination of the bladder is intermittent, and when urine is stored in the bladder in a certain amount, it causes a reflex action to urinate. Bladder voiding is caused by contraction of the sympathetic and parasympathetic innervated pelvic forceps and internal sphincter of the pelvic nerve and the external sphincter of the pubic nerve, which are not consciously innervated and the pubic nerve is consciously innervated. Whether the nerves are damaged or the internal and external sphincters and the forced urinary muscles are damaged, it can lead to the development of urinary retention.
The causes of urinary retention after extensive hysterectomy are: damage or severance of the pelvic floor nerves during surgery, resulting in reduced or lost bladder contraction; loss of bladder support after removal of the cervix and part of the vaginal wall, severance of the cervical ligament of the bladder, and poor bladder contraction; (bladder tissue is squeezed and rubbed by the surgeon during surgery, resulting in bladder tissue edema and reduced function; bladder is stripped from the cervix and vaginal wall After the bladder is removed from the cervix and vaginal wall, a large trauma is formed and this part loses its contractile function; after surgery, the patient feels pain and has a fear of urination. For a long time, acupuncture, hot compresses on the lower abdomen, listening to the sound of running water, bladder irrigation and prolonged catheterization have been used to reduce the occurrence of urinary retention. The length of hospital stay is long, the cost is high, and the chance of urinary tract infection is increased, which increases the patient’s pain.
During extensive hysterectomy, the bladder is detached from its attachment to the cervix and upper part of the vagina and pushed down to 3-4 cm of the cervix, resulting in a large area of bladder detachment, the bladder fascia is cut, the bladder loses its support, and the bladder tissue on the detached side is relatively weak and has poor contractile capacity. At the end of the operation, before suturing the pelvic floor peritoneum, two small purse-string sutures were made on the bladder stripping surface, and then the severed cervical ligament of the bladder and the separated bladder floor fascia were repaired and sutured to restore the integrity of the bladder fascia and restore the compliance of the bladder in turn.
This restores the bladder to its original tone and reduces the number of days of catheterization, which may well reduce the incidence of postoperative urinary retention. Cystofascial repair does not prolong the operation, does not increase intraoperative bleeding, and has no other side effects.