膀胱截石位取脐下小切口行宫颈癌根治术的探讨  

Investigation on Radical Operation of Cervical Cancer by Small Incision Below the Umbilicus with the Lithotomy Position

作　　者：曲军卫[1] 王金华[1] 王秀芬[1] 吴裕中[1] 邓斐[1] 

机构地区：[1]江苏省肿瘤医院,江苏南京210009

出　　处：《肿瘤学杂志》2014年第1期11-14,共4页Journal of Chinese Oncology

基　　金：江苏省医学重点人才项目(RC201191);江苏省"333"工程计划

摘　　要：[目的]探讨膀胱截石位时取脐下正中小切口行宫颈癌根治术治疗早期宫颈癌的临床结果。[方法]150例Ia2～Ⅱa期宫颈癌患者，均开腹行广泛全子宫切除术加盆腔淋巴结清扫术及腹主动脉旁淋巴结取样术。其中67例行膀胱截石位，切口位于脐下，称为截石位手术（1ithotomyposi-tionoperation，LPO）组，83例行水平仰卧位，切口绕脐左上，称为仰卧位手术（supinepositionopera-tion，SPO）组，进行临床相关指标的对比分析。[结果]LPO组淋巴结清扫数目和SPO组相当，切口长度、手术时间和出血量明显少于SPO组，有显著性差异fP〈0．05）；LPO组与SPO组术后相比，肛门排气时间和下床活动时间早，有显著性差异（P〈O．05）。LPO组没有发现膀胱截石位相关并发症的发生。[结论]膀胱截石位时行脐下正中小切口完全能够满足包括腹主动脉旁淋巴结取样术在内的宫颈癌根治术的要求，手术创伤小、恢复快，安全可行，临床疗效明显优于传统仰卧位手术，对早期宫颈癌手术的近期疗效具有显著的优越性。[Purpose] To investigate the clinical outcome of radical operation of cervical carcinoma by small incision below the umbilicus with the lithotomy position for early stage cervical cancer. [Methods] One hundred and fifty cases with cervical cancer stage I a2- II a underwent radical hysterectomy and pelvic lymphadenectomy and para-aortic lymph node biopsy.The incision was made in median of lower abdomen between umbilicus and pubis.Sixty-seven cases with incision below the umbilicus and with lithotomy position,were defined as LPO （lithotomy position operation） group,the incision of 83 cases around the navel then upper left horizontal with supine position,was defined as SPO（supine position op- eration）group.The clinical indexes between two groups were compared. [Results ] The number of dissect- ed lymph node were the same between LPO and SPO groups.While the incision length,operation time and blood loss were significantly less in LPO group than those in SPO group （P〈0.05）;moreover,af- ter operation,the anal exhaust time and the time out of bed were significantly earlier in LPO group than those in SPO group（P〈0.05）, and the anal exhaust time and the time out of bed were significantly earlier in LPO group than those in SPO group （P〈0.05）.No complication was found related to lithotomy position in LPO group. [Conclusions] The small incision below the umbilicus with the lithotomy position can completely meet the demands of radical surgery and para-aortic lymph node biopsy for cervical cancer due to little trauma,quick recovery,safe and feasible operation. Its clinical effect is obviously superior to the traditional operation with supine position, and it has obvious superiority on short term response for early stage cervical cancer.

关 键 词：宫颈肿瘤 膀胱截石位 脐下小切口 腹主动脉旁淋巴结活检 

分 类 号：R737.33[医药卫生—肿瘤]