子宫颈癌机器人广泛性全子宫切除术201例长期随访及回顾性分析  

Long-term follow-up and retrospective analysis of 201 cases of cervical cancer undergoing robotic extensive hysterectomy

作　　者：姚元庆 郭昕朦 李秀丽 田爽 晏红 杨怡卓 王晶 张晋宁 YAO Yuan-qing;GUO Xin-meng;LI Xiu-li;TIAN Shuang;YAN Hong;YANG Yi-zhuo;WANG Jing;ZHANG Jin-ning(Department of Obstetrics and Gynecology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;不详)

机构地区：[1]中国人民解放军总医院第一医学中心妇产科,北京100853 [2]南开大学医学院,天津300071 [3]中国人民解放军总医院第七医学中心妇产医学部,北京100010

出　　处：《中国实用妇科与产科杂志》2023年第8期829-832,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：北京市科委课题(Z131100006813023);北京市科委攻关课题(D08050703570903)。

摘　　要：目的探讨机器人手术系统在子宫颈癌手术中应用的可行性和安全性。方法回顾性分析2008年12月至2019年12月期间中国人民解放军总医院第一医学中心完成的ⅠA2~ⅡA2期及辅助化疗后ⅡB期子宫颈癌患者机器人手术的临床数据。采用达芬奇机器人手术系统完成广泛性全子宫切除术+盆腔淋巴结切除术。采集和分析手术时间、术中出血量、术中及术后并发症、术后平均住院时间等围手术期指标、病理检查结果和随访数据。采用Kaplan-Meier法计算生存率并绘制生存曲线,分别采用log-rank检验和Cox风险比例回归模型进行子宫颈癌机器人手术患者生存的单因素和多因素分析。结果完成201例机器人子宫颈癌广泛性全子宫切除和盆腔淋巴结切除术。手术时间(263.15±59.56)min,平均出血量100mL(中位数),术后平均住院时间(12.33±4.55)d。盆腔淋巴结切除数目(18.81±7.60)枚。平均随访时间72个月(中位数)。早期子宫颈鳞癌和腺癌(ⅠA2~ⅠB1期)术后5年生存率为96.3%。单因素和多因素分析显示,临床分期、肿瘤直径、淋巴脉管间隙浸润、宫旁浸润、病理类型、盆腔淋巴结转移是影响子宫颈癌患者预后的危险因素。结论机器人手术对于早期子宫颈癌治疗是可以选择的微创手术方法之一。Objective To evaluate the feasibility and safety of the application of robotic surgery system in cervical cancer surgery.Methods A retrospective analysis was conducted on clinical data of robotic surgeries performed onⅠA2-ⅡA2 andⅡB cervical cancer patients who underwent adjuvant chemotherapy between December 2008 and December 2019 in the General Hospital of Chinese PLA.The da Vinci robot surgical system was used to complete radical hysterectomy+pelvic lymphadenectomy.Perioperative indicators such as surgery time,intraoperative bleeding,intraoperative and postoperative complications,and average postoperative hospital stay,pathological examination results,and follow-up data were collected and analyzed.The Kaplan Meier method was used to calculate survival rates and plot survival curves.The log-rank test and Cox risk proportional regression model were used to conduct univariate and multivariate analyses of the survival of cervical cancer patients undergoing robotic surgery.Results Totally 201 robotic cervical cancer patients underwent radical hysterectomy and pelvic lymphadenectomy.The average surgery time was(263.15±59.56)minutes.The average bleeding volume was 100 mL(median),and the average postoperative hospital stay was(12.33±4.55)days.The number of pelvic lymph node resected was 18.81±7.60.The average follow-up time was 72 months(median).The 5-year postoperative survival rate for early cervical squamous cell carcinoma and adenocarcinoma(ⅠA2-ⅠB1 stage)was 96.3%.Univariate and multivariate analysis showed that clinical stage,tumor diameter,vascular infiltration,periuterine infiltration,pathological type,and pelvic lymph node metastasis were risk factors affecting the prognosis of cervical cancer patients.Conclusion Robotic surgery is one of the minimally invasive surgica methods that can be chosen for the treatment of early cervical cancer.

关 键 词：子宫颈癌 广泛性全子宫切除术 机器人手术 

分 类 号：R737.3[医药卫生—肿瘤]