早期宫颈癌腹腔镜和开腹根治性手术的病例对照研究  

A Case-control Study on Laparoscopic Versus Abdominal Radical Hysterectomy with Pelvic Lymphadenectomy for Earlystage Cervical Cancer

作　　者：李萌[1] 侯征[1] 王颖[1] 熊光武[1] 乔杰[1] 郭红燕[1] 韩劲松[1] 张璐芳[1] 朱馥丽[1] 梁华茂[1] 李华[1] 吴郁[1] 张坤[1] 

机构地区：[1]北京大学第三医院妇产科,北京100191

出　　处：《中国微创外科杂志》2014年第11期969-972,980,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的：探讨腹腔镜宫颈癌根治手术的可行性、安全性及优势。方法回顾性分析2005年1月～2010年3月广泛子宫切除＋盆腹腔淋巴结切除术治疗的早期宫颈癌（ⅠB～ⅡA期）患者资料，根据患者年龄、肿瘤分期、肿瘤组织学类型和淋巴结转移情况对接受腹腔镜和开腹手术的患者进行1∶1配对病例对照分析，2组各21例。比较2组手术指标、术后病理结果及随访结果。结果2组手术时间及并发症发生率差异无显著性，腹腔镜组术中出血少[（233．3±202．1） ml vs．（983.3±462．2）ml，t＝-6．814，P＝0．000]，术后排气早[（41．0±13．9）h vs．（55．4±15．0）h，t＝-3．219，P＝0．003]，但清扫盆腹腔淋巴结数量较少[（19．7±8．2）枚vs．（27．5±7．7）枚，t＝-3．170，P＝0．003]，术后留置尿管时间较长[（31．8±23．4） d vs．（14．5±4.7）d，t＝3．177，P＝0．005]。失访腹腔镜组13例，开腹组12例，其余17例中位随访时间53个月（53～107个月），肿瘤复发率差异无显著性[0（0／8） vs．11．1％（1／9），P＝1．000]。结论腹腔镜早期宫颈癌根治手术是安全可行的，在严格把握手术适应证的情况下，可替代开腹手术。腹腔镜手术还具有术中失血少、术后恢复快等优势。经过中期随访观察，效果满意。Objective To determine whether total laparoscopic radical hysterectomy （ TLRH ） is a feasible alternative to abdominal radical hysterectomy （ ARH ） in the treatment of early-stage cervical cancer （ stage ⅠB -ⅡA ） . Methods The outcomes of 42 patients with cervical cancer （stageⅠB-ⅡA） who underwent laparoscopic （LPS group, n=21） or laparotomic （LPT group, n=21） radical hysterectomy and pelvic lymphadenectomy in our hospital from January 2005 to March 2010 were retrospectively estimated.All of the patients from the LPT group were matched 1∶1 with the patients from the LPS group based on stage , age, histological subtype , and nodal status for case-controlled analysis .The parameters were compared between two groups including operating time, intra-operative blood loss, number of lymph nodes resected, gastrointestinal recovery time, intra-and post-operative complications , hospital stay , relapse and mortality rate . Results The operating time and complications were similar between the two groups.The LPS group had less intra-operative blood loss [（233.3 ±202.1） ml vs.（983.3 ±462.2） ml, t=-6.814, P=0.000] and shorter gastro-intestinal recovery time [（41.0 ±13.9） h vs.（55.4 ±15.0） h, t=-3.219, P=0.003] as compared with the LPT group.However, the LPS group showed less lymph nodes resected [（19.7 ±8.2） vs.（27.5 ±7.7）, t=-3.170, P=0.003] and longer indwelling catheter time [（31.8 ±23.4） d vs.（14.5 ±4.7） d, t=3.177, P=0.005] as compared with the LPT group.Follow-up visits for 53-107 months （median, 53 months） in 17 patients （with 13 patients in LPS group and 12 patients in LPT group lost of follow-up） found the relapse rate was similar between the two groups [0 （0/8） vs.11.1% （1/9）, P=1.000]. Conclusions It is feasible to do radical hysterectomy and pelvic lymphadenectomy by laparoscopy instead of laparotomy for early -stage cervical cancer .Laparoscopy shows more favorable operative outcomes after mid-term follow-up time.

关 键 词：宫颈癌 早期 广泛子宫切除 腹腔镜手术 

分 类 号：R737.33[医药卫生—肿瘤]