腹腔镜与开腹子宫内膜癌分期手术的临床对比研究  

Comparison of surgery for staging using laparoscopy and laparotomy in patients with endometrial cancer

作　　者：林小娜[1] 童晓嵋[1] 竺海燕[1] 黄东[1] 匡琳[1] 赵小峰[1] 宋光辉[1] 王敏珍[1] 方素华[1] 张松英[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院妇产科、浙江大学邵逸夫医院临床医学研究所,杭州310016

出　　处：《中华医学杂志》2010年第35期2491-2494,共4页National Medical Journal of China

基　　金：基金项目：浙江省科技厅资助项目（2007C33031）

摘　　要：目的 探讨腹腔镜下分期手术治疗子宫内膜癌的必要性和可行性.方法 回顾性分析56例子宫内膜癌分期手术患者,比较腹腔镜和开腹两组的围手术期情况 分析术前术后分期的差异及原因.结果 手术时间腹腔镜组（213±49）min,开腹组（162±30）min 手术后血红蛋白下降值腹腔镜组为（12±8）g/L,开腹组为（19±8）g/L 差异有统计学意义（P＜0.05）.腹腔镜组术后住院时间、肛门恢复排气时间均短于开腹组,差异有统计学意义（P＜0.01）.两组留置导尿管时间、术后并发症发生率、淋巴结切除数量、住院费用等方面差异均无统计学意义（均P＞0.05）.临床与手术病理分期总符合率为57.14%.结论 腹腔镜下分期手术可作为早期子宫内膜癌的主要治疗术式.Objective To compare the surgical outcomes for staging by laparoscopy and laparotomy in patients with endometrial cancer, evaluate the feasibility of laparoscopic surgical treatment of endometrial cancer, compare the difference between clinical and surgical staging of endometrial cancer and elucidate the advantages and feasibility of its surgical staging. Methods Fifty-six patients diagnosed pre-operatively as stage Ⅰ endometrial cancer were reviewed for surgery for staging. They were assigned into laparoscopic group （ n = 34 ） and laparotomic （ open ） group （ n = 22）. The operative parameters including operating time, intraoperative blood loss, the number of lymph nodes removed, gastrointestinal recovery time, urinary catheterization time, complications and post-operative hospital stay were compared. Results The preoperative clinical characteristics before operation between two groups were similar. No significant differences were found in age and body mass index between two groups. As compared with the open group, the laparoscopic group had a longer operation time （213 min ±49 min vs 162 min ±30 min, P 〈0. 05）, less hemoglobin change （ 12 g/L ±8 g/L vs 19 g/L ±8 g/L, P 〈0. 05）, shorter hospital stay （6. 3 d ± 1.7 d vs 9.5 d ± 1.8 d, P 〈0. 01 ） and shorter gastrointestinal recovery time （ 1.8 d ±0. 6 d vs 2. 7 d ± 1.2 d, P 〈0. 01 ）. While there was no significant difference between two groups in the number of lymph nodes removed,urinary catheterization time, costs and complications. The total coincidence was 57. 14% between clinical and surgical staging. Conclusion Laparoscopic staging surgery is both feasible and safe in the treatment of endometrial cancer. And the surgical staging truly reflects the extent of cancer invasion and it is thus necessary for early-stage endometrial cancer.

关 键 词：子宫内膜癌 腹腔镜手术 分期手术 

分 类 号：R737.33[医药卫生—肿瘤]