腹腔镜与开腹行子宫广泛性切除术治疗Ia2～Ⅱb期子宫颈癌安全性及有效性的比较  

Comparison of safety and efficacy of laparoscopic versus abdominal radical hysterectomy in the treatment of patients with stage I a2- Ⅱ b cervical cancer

作　　者：杨露[1] 杨萍[2] 李东林[3] 蔡晶[1] 沈怡[1] 董卫红[1] 张媛[1] 熊宙芳[1] 陈辉[1] 闵洁[1] 汪宏波[1] 王英红[2] 梁文通[3] 王泽华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院妇产科,武汉430022 [2]石河子大学医学院第一附属医院妇产科 [3]贵州省人民医院妇产科

出　　处：《中华妇产科杂志》2015年第12期915-922,共8页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的比较腹腔镜与开腹行子宫广泛性切除术治疗Ia2～Ⅱb期子宫颈癌的安全性及有效性。方法收集2000年至2015年华中科技大学同济医学院附属协和医院、石河子大学医学院第一附属医院及贵州省人民医院收治的确诊为Ia2～IIb期子宫颈癌的1529例患者的临床病理资料并进行回顾性分析。其中，1052例患者接受腹腔镜下行子宫广泛性切除术（LRH）＋盆腔淋巴清扫术（腹腔镜组），477例接受开腹行子宫广泛性切除术（ARH）＋盆腔淋巴清扫术（开腹组）。比较两组患者的手术相关指标、术中和术后并发症、预后的差异。结果（1）临床病理指标：腹腔镜组、开腹组患者的临床分期、病理类型、淋巴结转移、宫旁浸润、新辅助化疗分别比较，差异均有统计学意义（P〈0．05）。因资料不均衡，进一步按临床分期进行分层，分为Ia2～Ib1期861例，包括663例腹腔镜组、198例开腹组；Ib2-Ⅱb期668例，包括389例腹腔镜组、279例开腹组。按临床分期分层后，分别在Ia2-Ib1期和Ib2-Ⅱb期子宫颈癌中，两组患者的年龄、病理类型、病理分化程度、宫旁浸润、淋巴脉管间隙受累（LVSI）及新辅助化疗分别比较，差异均无统计学意义（P〉0．05）。（2）手术相关指标：按临床分期分层后，分别在Ia2-Ib1期和Ib2～Ⅱb期患者中，腹腔镜组手术时间（中位数均为240min）明显长于开腹组（中位数均为220Min；P=0．027，P=0．000），术中出血量（中位数分别为200、300m1）显著少于开腹组（中位数均为500ml；P值均为0．000），术中输血率（分别为14．3％、22．6％）显著低于开腹组（分别为53．5％、48．4％；P值均为0．000）。（3）术中、术后并发症：按临床分期分层后，分别在Ia2-Ibl期和Ib2-IIb期中，腹腔镜组与开腹组术中并发症、术后并发症（除外尿潴留）及尿潴留的发生率比较，差异均无统�Objective To compare the safety and efficacy after laparoscopic radical hysterectomy （LRH） and abdominal radical hysterectomy （ARH） in the treatment of patients with stage I a2-Ⅱ b cervical cancer. Methods In a retrospective study, data were analyzed from patients with International Federation of Gynecology and Obstetrics （FIGO） stage I a2- Ⅱ b cervical cancer underwent LRH or ARH at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; First Affiliated Hospital, School of Medicine, Shihezi University; and the Guizhou Provincial People＇ s Hospital between 2000 and 2015. Perioperative outcomes and survival analysis were compared. Results （1） The FIGO stages, histotypes, metastasis of lymph nodes, lymph vascular space invasion and neoadjuvant chemotherapy significantly differed between the LRH group and the ARH group （all P〈0.05）. In order to eliminate the effects by the unbalanced data, stratified analysis was conducted based on FIGO stage. There were 861 patients in stage I a2- I bl group, including 663 patients in LRH group and 198 patients in ARH group. And there were 668 patients in stage I b2- Ⅱ b group, including 389 patients in LRH group and 279 patients in ARH group. （2） In the patients with stage I a2- I bl and I b2- Ⅱb tumor, there were no significant difference in age, histotype, differentiation degree, parametrial invasion, lymphvasular invasion space and neoadjvant chemotherapy between the LRH group and the ARH group （all P〉0.05）. For patients with stage I a2- I bl, the operation time in the LRH group was longer than that in the ARH group （P=0.027）, and it showed less blood loss and lower blood transfusion rate in the LRH group than those in the ARH group （all P=0.000）. The findings were similar in the patients with stage I b2- IIb （all P=0.000）. （3） There were no significant difference in intraoperative complications and postoperative complications between the LRH and the ARH group in the patients with stage

关 键 词：宫颈肿瘤 子宫切除术 腹腔镜检查 

分 类 号：R737.33[医药卫生—肿瘤]