早期卵巢上皮性癌经腹腔镜与开腹行全面分期手术的临床对比分析  

Clinical comparative analysis of comprehensive laparoscopic and laparotomic staging of early-stage epithelial ovarian cancer

作　　者：熊维[1] 曹莉莉[1] 蒋路频 夏欢[1] 梁志清[1] Xiong Wei Cao Lili Jiang Lupin Xia Huan Liang Zhiqing(Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing 400038, Chin)

机构地区：[1]第三军医大学西南医院妇产科,重庆400038

出　　处：《中华妇产科杂志》2017年第2期103-109,共7页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的 通过比较早期（Ⅰ~Ⅱ期）卵巢上皮性癌（卵巢癌）经腹腔镜与开腹行全面分期手术的有效性和安全性,探讨腹腔镜在早期卵巢癌全面分期手术中的价值.方法 收集2007年11月至2014年11月在第三军医大学西南医院收治的行全面分期手术的早期卵巢癌患者共102例,根据不同手术途径分为腹腔镜组（71例）、开腹组（31例）,中位随访时间为50.5个月（3~103个月）,比较两组患者的围手术期相关指标、术后并发症和远期疗效.结果 （1）围手术期相关指标：与开腹组比较,腹腔镜组术中出血量[分别为（631±463）、（288±239）m1]明显减少,输血率（分别为58%、14%）明显降低,盆腔淋巴结切除数[分别为（15.5±4.6）、（18.1±5.6）个]明显增多,术后疼痛评分[分别为（3.0±1.1）、（2.1±1.6）分]明显降低,术后肛门排气时间[分别为（3.5±0.9）、（2.6±0.8）d]明显缩短,术后住院时间[分别为（11.3±5.0）、（9.9±2.9）d]明显缩短,两组上述指标分别比较,差异均有统计学意义（P〈0.01）;而两组手术时间、腹主动脉旁淋巴结切除数、术后分期上升率、术后辅助化疗率分别比较,差异均无统计学意义（P〉0.05）.（2）术后并发症：腹腔镜组、开腹组术后并发症发生率分别为11%（8/71）、19%（6/31）,两组比较,差异无统计学意义（χ2=1.192,P=0.275）.（3）远期疗效：随访期内,腹腔镜组、开腹组患者的复发率分别为17%（11/66）、14%（4/29）,两组比较,差异无统计学意义（χ2=0.125,P=0.724）;腹腔镜组、开腹组患者的5年生存率分别为86.7%和86.8%,两组比较,差异无统计学意义（P=0.874）.结论 与开腹手术相比,早期卵巢癌腹腔镜行全面分期手术具有微创、出血少、术后疼痛轻及恢复快等优势,并且复发率和生存率无显著差异,可作为早期卵巢癌手术治疗方式的选择.Objective To investigate the value of laparoscopy in comprehensive early ovarian cancer staging by comparing the feasibility and safety of laparoscopy and laparotomy in surgical staging of early-stage epithelial ovarian cancer （EOC）. Methods A total of 102 patients with EOC who underwent comprehensive laparoscopic （LPS group, n=71） or laparotomic （LPT group, n=31） staging at Southwest Hospital from November 2007 to November 2014 were retrospectively analyzed. The perioperative parameters, postoperative complication rate and the long-term curative effect were compared between the two groups. Results （1）LPS group had less intra-operative blood loss [（288±239） vs （631±463） ml], lower rate of blood transfusion（14%vs 58%）, larger number of pelvic dissected lymph nodes （18.1±5.6 vs 15.5± 4.6）, lower vasual analogue scalescore（VAS） pain score （2.1 ± 1.6 vs 3.0 ± 1.1）, shorter gastrointestinal recovery time [（2.6 ± 0.8） vs （3.5 ± 0.9） days] and shorter hospital stay [（9.9 ± 2.9） vs （11.3 ± 5.0） days] when compared with LPT group （all P〈0.01）. No significant difference were found in operation time, number of para-aortic lymph nodes, rate of postoperative upstaging and adjuvant chemotherapy between the two groups （all P〉0.05）. （2） No significant difference was found in postoperative rate of complications [11%（8/71） vs 19%（6/31）,χ2=1.192, P=0.275]. （3） No significant difference was found in recurrence rate [17%（11/66） vs 14%（4/29）, χ2=0.125, P=0.724] and 5-year overall survival （86.7% vs 86.8%, P=0.874）. Conclusion Compared with LPT group, there are no significance differences in recurrence rate and mortality between two groups, laparoscopic staging, which could be recommended as a choice of surgical treatment of early ovarian cancer, shows more favorable operative outcomes including minimally invasive, less intra-operative blood loss, less postoperative pain and quicker recovery.

关 键 词：卵巢肿瘤 腹腔镜检查 剖腹术 肿瘤分期 对比研究 

分 类 号：R737.31[医药卫生—肿瘤]