腹腔镜手术治疗早期子宫恶性肿瘤23例

目的探讨腹腔镜手术治疗早期子宫恶性肿瘤的可能性和安全性.方法采用电视腹腔镜技术对23例早期子宫恶性肿瘤患者进行手术治疗,其中16例子宫内膜癌施行腹腔镜下广泛子宫切除加双附件切除术,5例子宫颈癌及另2例子宫体癌行腹腔镜下盆腔淋巴结清扫加广泛子宫切除术.结果腹腔镜广泛子宫切除术平均手术时间215.44min,术中失血量278.38 ml,腹腔镜盆腔淋巴结清扫加广泛子宫切除术平均手术时间300.86 min,术中失血量550 ml.术中无一例脏器损伤.平均住院时间8天.结论开展腹腔镜手术治疗早期子宫恶性肿瘤是可行的,安全的,值得研究与运用.     

腹腔镜手术治疗子宫恶性肿瘤72例临床分析

目的探讨子宫恶性肿瘤腹腔镜手术治疗的可行性与实用价值.方法对2000年8月至2005年1月间沈阳市妇婴医院26例子宫颈癌和6例子宫内膜癌行腹腔镜下广泛或次广泛子宫切除及盆腔淋巴结清扫术,对33例子宫内膜癌行筋膜外子宫全切、双附件切除及盆腔淋巴结清扫术,对7例Ⅰb1期前子宫颈癌患者行腹腔镜下盆腔淋巴结清扫术及宫颈根治术.分析其手术时间、术中出血量、淋巴结清除数目、术后恢复情况.结果腹腔镜下广泛(或)次广泛子宫切除术及盆腔淋巴结清扫术的平均手术时间(261±62)min,平均出血量(357±46)mL,平均清除淋巴结(21.7±4.5)个.术后尿潴留9例.结论子宫恶性肿瘤的腹腔镜手术因其独具优势而有发展前景,手术成功的关键在于适应证的正确选择及操作技术的熟练.     

腹腔镜手术治疗子宫恶性肿瘤52例分析

目的　总结腹腔镜手术治疗子宫恶性肿瘤的临床资料。方法　 1999年 8月至 2 0 0 2年 7月对 37例子宫内膜癌 ,15例子宫颈癌行腹腔镜手术 ,其中广泛全子宫切除加双附件切除术 30例 ,广泛全子宫切除加双附件切除加盆腔淋巴结清扫术 2 2例 ;对子宫内膜癌Ⅰb期G2 、G3 的 14例患者同时行腹主动脉旁淋巴结活检术。结果　 37例子宫内膜癌全部手术成功 ,无一例出现术中并发症 ,平均手术时间 (2 2 0 4 0± 4 7 89)min ,出血量 (96 6 7±33 39)mL ,术前、后诊断符合率 :Ⅰa期 2 0 0 0 % ,Ⅰb期 6 1 90 % ,术后 3年阴道残端复发 1例 ;15例子宫颈癌患者中 ,中转开腹 1例 ,髂外静脉损伤 2例 ,平均手术时间 (316 11± 6 3 2 4 )min ,出血量 (381 6 7± 74 0 9)mL ,平均切除淋巴结 (18 4 3± 1 6 3)粒 ,术后 1年盆腔侧壁复发 1例。腹腔镜手术治疗子宫恶性肿瘤成功率 98 0 8%。结论　腹腔镜手术治疗子宫恶性肿瘤近期效果良好 ,远期效果有待随访。     

腹腔镜下淋巴结切除治疗妇科恶性肿瘤的临床分析

目的 探讨腹腔镜下广泛子宫切除和盆,腹腔淋巴结切除用于妇科恶性肿瘤的可行性及价值。方法 对子宫内膜癌21例,子宫颈癌25例患者,根据病变部位和淋巴结切除术适应证,行盆腔淋巴结切除术,其中对30例患者行选择性腹主动脉周围淋巴结切除,再行腹腔镜辅助阴式广泛子宫切除术。结果 腹腔镜下手术时间平均为3.1h,术中出血平均198ml。切除淋巴结数平均16个。术后住院时间平均9.6d。术中发生膀胱损伤2例。静脉损伤2例。1例大肠损伤术中转行开腹术,术后仅1例于1个月后出现双侧输尿管轻度狭窄,1例术后1个月出现肿瘤穿刺孔转移,3例出现尿潴留,其余无明显并发症发生。结论 对妇科恶性肿瘤施行腹腔镜下广泛子宫切除和盆,腹腔淋巴结切除术安全可靠;淋巴结切除彻底,且手术创伤小,并发症少,术后恢复快。     

子宫颈癌患者腹腔镜下广泛子宫切除术联合淋巴结切除术的临床效果评估

目的 评估腹腔镜下广泛子宫切除术联合盆腹腔淋巴结切除术用于治疗子宫颈癌的临床效果。方法 对57例Ⅰa～Ⅱb期的子宫颈癌患者,施行腹腔镜下广泛子宫切除术联合盆腔及腹主动脉周围淋巴结切除术。其中子宫颈鳞状细胞癌48例,腺癌7例,腺鳞癌2例。结果 除2例外,所有患者均在腹腔镜下完成手术,平均手术时间为186min(150～320min),术中平均出血168ml(120～700ml),切除盆腔和腹主动脉周围淋巴结数量平均为18．6个和8．2个;8例患者淋巴结为阳性。所有切除组织边缘大体检查均为阴性。术中2例膀胱损伤、1例静脉损伤,均于镜下修补成功;2例中转开腹。术后肛门排气时间平均为2．3d,恢复自主排尿时间平均为10．2d。手术后每3个月随访1次,发现轻度输尿管狭窄1例,尿潴留2例,阴道残端复发3例,病情未控1例。结论 腹腔镜下广泛子宫切除术联合盆腹腔淋巴结切除术j治疗子宫颈癌手术创伤小、并发症少、术后恢复快,是一种治疗子宫颈癌的理想方法。     

经阴道子宫广泛切除联合腹腔镜手术治疗子宫恶性肿瘤的临床研究

目的：探讨经阴道子宫广泛或次广泛切除加腹腔镜手术治疗子宫恶性肿瘤的可行性和临床效果。方法：对18例宫颈癌患者,5例子宫内膜癌患者,行经阴道子宫广泛或次广泛切除加腹腔镜盆腔淋巴结清除术。分析手术质量和术后恢复情况。结果：23例患者均顺利完成手术,无并发症发生。清除的盆腔淋巴结数平均29个,平均手术时间为216分钟,术中平均出血350 ml,3例需要输血。术后肛门排气时间平均1．8天,膀胱功能恢复时间平均11．5天,平均术后住院时间9．5天。术后第一天均可下地活动。22例无复发。结论：该术式损伤小、恢复快,能达到足够的切除范围,是目前治疗子宫恶性肿瘤较理想的术式。     

腹腔镜手术治疗子宫恶性肿瘤8例分析

目的 探讨腹腔镜手术治疗子宫恶性肿瘤的临床效果。方法 对6例子宫内膜癌患者行腹腔镜下广泛全子宫切除＋双侧附件切除术;对2例子宫颈癌患者行腹腔镜下广泛全子宫切除＋双侧附件切除＋盆腔淋巴结切除术。观察手术时间、平均出血量及术后恢复情况。结果 广泛全子宫切除＋双侧附件切除术6例,平均手术时间220min,平均出血量200ml;腹腔镜下广泛全子宫切除＋双侧附件切除＋盆腔淋巴结切除术2例,平均手术时间240min。术中无一例脏器损伤、术后平均住院8d。结论 腹腔镜手术创伤小、恢复快、对早期子宫恶性肿瘤具有较好治疗效果。     

广泛性子宫切除术后留置尿管时间与膀胱功能恢复的关系

广泛性子宫切除是治疗子宫颈癌和子宫内膜癌的经典手术，常同时进行盆腔淋巴结清扫。由于该手术对盆腔交感和副交感神经的损伤，术后常并发膀胱功能障碍。因此，广泛性子宫切除术后应留置尿管多长时间是妇科医生经常面临的问题。为此，我们对220例进行广泛性子宫切除手术的病人，分组对照研究术后留置尿管的时间与膀胱功能恢复的关系，并分析其影响因素。     

腹腔镜与开腹手术行广泛子宫切除加盆腔淋巴结清除术的临床效果比较

目的 比较腹腔镜与开腹手术行广泛子宫切除加盆腔淋巴结清除术的临床效果。方法 回顾性分析近2年我院经腹腔镜行广泛子宫切除加盆腔淋巴结清除术的26例子宫恶性肿瘤患者(腹腔镜组)的临床资料,随机抽取近4年行开腹同类手术的27例(开腹组)作为对照。结果腹腔镜组平均手术时间为310 min,开腹组为238 min;腹腔镜组平均切除的淋巴结22个,开腹组为16个;腹腔镜组术中平均出血量为756 ml,开腹组为1129 ml,腹腔镜组平均输血量为321 m1,开腹组为746 ml,腹腔镜组平均术后排气时间为37 h,开腹组为62 h;腹腔镜组术后体温恢复正常时间平均为5 d,开腹组为8 d;腹腔镜组平均应用抗生素时间为6 d,开腹组为8 d;以上各项数据两组间比较,差异均有极显著性(P<0.01)。两组在盆腔引流液(分别为321、216 ml)、尿管拔除时间(分别为13、10d)、术后第3天的白细胞计数(分别为11 × 109/L、10 × 109/L)、术后住院日(分别为26、26 d)及住院费用(分别为25 986、22 672元)等方面比较,差异均无显著性(P>0.05)。结论 腹腔镜下广泛子宫切除及盆腔淋巴结清除术可达到开腹手术的彻底性,并具有创伤小、恢复快等优点。     

根治性子宫颈切除术和腹腔镜下淋巴结切除术在早期子宫颈癌治疗中的应用

目的 探讨根治性子宫颈切除术和腹腔镜下淋巴结切除术,在早期子宫颈癌治疗中的可行性和效果。方法2001年8月至2003年5月,对12例Ⅰ a期至Ⅰ b2期的子宫颈癌患者,施行腹腔镜下盆腔淋巴结切除术,切除的盆腔淋巴结经病理学检查证实无淋巴结转移者,随即行根治性子宫颈切除术,保留子宫体。结果 12例患者均在腹腔镜下完成盆腔淋巴结切除术,淋巴结检查均为阴性;根治性子宫颈切除术均经阴道完成,平均手术时间142 min(115—178 min),术中出血量约180 ml(120—230 ml)。术后无感染及出血,平均住院时间6.7 d。经随访3—28个月,1例患者妊娠,无一例肿瘤复发。结论 对于未生育且强烈要求保留生育功能的早期子宫颈癌患者,行腹腔镜下盆腔淋巴结切除术和根治性子宫颈切除术是可行的;手术创伤小,术后患者恢复快。     

腹腔镜广泛子宫切除术及盆腹腔淋巴结切除术23例并发症分析

目的 探讨因宫颈癌及子宫内膜癌行腹腔镜广泛子宫切除术和盆腹腔淋巴结切除术患者的并发症发生情况及防治方法。方法 回顾性分析我院2000年7月至2004年12月间,278例宫颈癌及子宫内膜癌患者的腹腔镜广泛子宫切除术及盆腔、腹主动脉周围淋巴结切除术的临床资料。结果 278例腹腔镜广泛子宫切除术及盆腹腔淋巴结切除术中,除4例中转开腹外,其余手术均在腹腔镜下完成,其中有108例患者行腹主动脉周围淋巴结切除术。4例中转开腹手术者中,3例为急诊开腹手术,1例为选择性开腹手术。278例中共发生各类并发症23例,术中并发症13例,其中血管损伤7例,5例在腹腔镜下行血管修补或结扎,1例髂外静脉损伤者开腹行血管吻合术,1例开腹止血;膀胱损伤4例,均在腹腔镜下行修补术;1例患者因高碳酸血症中转开腹手术;另1例患者因结肠损伤而中转开腹行肠修补术。术后并发症10例,其中3例输尿管阴道瘘,3例膀胱阴道瘘,需再次手术治疗;1例输尿管狭窄;3例尿潴留。结论 腹腔镜广泛子宫切除术及盆腔、腹主动脉周围淋巴结切除术正在逐渐成为妇科的常规手术,其最常见的并发症是血管损伤和膀胱损伤。     

Feasibility and morbidity of total laparoscopic radical hysterectomy with or without pelvic limphadenectomy in obese women with stage I endometrial cancer

Objective  The aim of this study was to describe the feasibility and morbidity rates associated with total laparoscopic radical hysterectomy (TLRH) with or without pelvic lymphadenectomy for stage I endometrial cancer in obese women. Patients and methods  Obese patients with stage I endometrial cancer who underwent total laparoscopic radical surgery at the Department of Obstetrics and Gynecology of San Gerardo Hospital were compared to nonobese patients. The same group of obese patients was compared with patients who underwent radical laparotomic surgery. Obesity was defined as a body mass index more than 30 kg/m². Results  Between September 2003 and September 2007, 75 women underwent TLRH. Median age was 54 years and median body mass index was 28 kg/m². Thirty-seven women were obese. There were no differences between nonobese and obese women in operative, time length of parametria and pelvic nodes removed and operative or late complications. Blood loss was significantly higher in obese patients. Comparing retrospectively laparoscopy and laparotomy in obese women treated in our center, laparotomy was associated with decreased operative time, but also with increased blood loss, transfusion rate, duration of hospitalization and frequency of post surgical complications. Conclusions  Total laparoscopic radical hysterectomy (with pelvic lymphadenectomy) is a safe option in patients with endometrial cancer. Obesity is not a contraindication to perform a TRLH with no differences in surgical parameters between obese and nonobese population. TLRH show a significant decrease of complications compared to laparotomic radical surgery in obese women.     

腹腔镜下和经腹广泛子宫切除及盆腔淋巴结切除术治疗早期子宫恶性肿瘤的临床效果比较

目的:比较腹腔镜下和经腹广泛子宫切除及盆腔淋巴结切除术治疗子宫恶性肿瘤的临床效果。方法:对我院2008年9月～2010年12月68例早期子宫恶性肿瘤患者行腹腔镜下广泛子宫切除及盆腔淋巴结切除术(腹腔镜组),随机抽取同期60例经腹广泛子宫切除及盆腔淋巴结切除术的病例做对照(开腹组),比较两种术式的手术相关情况,术后恢复情况,手术并发症及术后生存质量等。结果:行腹腔镜手术的68例患者中无1例中转开腹,腹腔镜组在手术时间,术中出血量,淋巴结切除数目,手术并发症,术后住院日和术后体温恢复时间与开腹组相比具有明显优势,差异具有统计学意义(P<0.05);但在膀胱功能恢复时间,盆腔引流液,尿管拔出时间等方面比较,差异无显著意义(P>0.05)。结论:腹腔镜下广泛子宫切除及盆腔淋巴结切除术可达到开腹手术的安全性及有效性,并具有创伤小,术野清晰,并发症少,恢复快等优点,为微创手术治疗妇科恶性肿瘤提供了良好的应用前景。     

Place of Schauta's radical vaginal hysterectomy

Women affected by early stage invasive cancer of the cervix are usually treated by surgery. Radical abdominal hysterectomy with pelvic lymphadenectomy is the most widely used technique. Because the morbidity of the abdominal approach can be important, the radical vaginal hysterectomy has gained acceptance in gynaecologic oncology. New instrumentation in laparoscopy also opens the possibility of treating cervical cancer by laparoscopically assisted vaginal radical hysterectomy and also total laparoscopic radical hysterectomy. Before these techniques become widely accepted, it has to be shown that safety and efficacy are comparable with the 'standard' abdominal approach. In this chapter, we review the technique of radical vaginal hysterectomy with pelvic lymphadenectomy and evaluate results of published studies, comparing the abdominal, vaginal and laparoscopic approaches.     

Caring for stage IB cancer of the cervix. Proposal for a protocol based on a review of the literature

A review of the literarure indicates that there are two essential prognostic factors in stage Ib cancer of the cervix: the size of the tumour (determined by a physical examination and MRI) and invasion of the lymph nodes (determined by lymphadenectomy). Of the available means of treatment, many workers use surgery at stage Ib1 and a combination of chemotherapy and radiotherapy at stage Ib2. Hence, our pre-therapeutic assessment usually includes a physical examination under general anaesthesia, MRI of the abdomen and pelvis, and laparoscopic pelvic lymphadenectomy for stage Ib1 and laparoscopic lumbo-aortic lymphadenectomy for stage Ib2. For stage Ib1 < 2 cm, if extemporaneous examination of the pelvic lymph nodes is positive, we perform lymphadenectomy of the lumbo-aortic lymph nodes and initiate treatment with chemotherapy and radiotherapy. If pelvic lymphadenectomy gives negative results in a woman who does not wish to remain fertile, we carry out radical vaginal hysterectomy (Schauta-Stoeckel) rather than radical hysterectomy (Piver 2) by laparotomy or laparoscopy. If the margins are healthy and devoid of vascular or lymphatic involvement, no further treatment is given. If this is not the case, we suggest a postoperative radio-chemotherapy. For patients who wish to retain their fertility, we carry out radical cervicectomy. For tumours measuring between 2 and 4 cm, and if pelvic lymphadenectomy is positive, we propose radio-chemotherapy, or radical hysterectomy as for small tumours. For Ib2 tumours, and if no lumbar adenopathy is seen at MRI, we perform a lumbo-aortic lymphadenectomy, followed by a radio-chemotherapy. If invasion of lumbar lymph nodes is suspected at MRI, we perform a biopsy on the left scalenic lymph nodes; if invasion is present at this level, we give palliative treatment with simple pelvic radiotherapy. If lumbo-aortic lymphadenectomy reveals invasion, radiotherapy is directed at these nodes. If, at the end of combined chemotherapy and radiotherapy, some remaining tumour is discovered at the MRI assessment, we carry out extrafacial hysterectomy.     

Sentinel lymph node identification and radical hysterectomy with lymphadenectomy in early stage cervical cancer: laparoscopy versus laparotomy

STUDY OBJECTIVE: To estimate the feasibility and results of sentinel lymph node identification and radical hysterectomy with pelvic lymphadenectomy entirely completed by laparoscopy versus laparotomy in early stage cervical cancer. DESIGN: Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). SETTING: Acute care, teaching hospital. PATIENTS: From September 2000 through January 2005, 50 consecutive patients with International Federation of Gynecology and Obstetrics stage IA(2), IB(1), and IIA disease less than 4 cm underwent radical hysterectomy and lymphadenectomy with intraoperative sentinel lymph node biopsy. INTERVENTIONS: The operation was performed entirely by laparoscopy in 20 patients and using the conventional abdominal approach in 30. Feasibility of sentinel lymph node identification, surgical morbidity, overall survival, and recurrence rate-free survival in both groups were compared. MEASUREMENTS AND MAIN RESULTS: The overall detection rate of the sentinel lymph node was 100% (false negative 0%). A mean of 2.50 sentinel nodes/patient was detected in the laparotomy group compared with a mean of 2.55 nodes in the laparoscopic group (p = .874). Bifurcation of the right common iliac artery was the most frequent nodal location. Blood loss and length of stay were significantly lower in the laparoscopic group, but surgical time was significantly longer. The median follow-up was 35 months (range 5-57) in the laparotomy group and 22.5 (range 2-52) in the laparoscopic group. Differences in overall survival and disease-free survival were not observed. CONCLUSION: Sentinel lymph node identification and radical hysterectomy in the initial treatment of early stage cervical cancer can be performed safely by laparoscopy with lower morbidity and overall survival and recurrence-free survival similar to standard laparotomy.     

Comparison of laparoscopic and conventional surgery in the treatment of early cervical cancer

STUDY OBJECTIVE: To compare efficacy, results, and complications of laparoscopic-assisted radical hysterectomy (LARH) and pelvic lymphadenectomy with abdominal radical hysterectomy (ARH) and pelvic lymphadenectomy in management of early (stages 1a2, 1b) invasive cervical carcinoma. DESIGN: Prospective cohort study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Sixty women enrolled for radical hysterectomy as most appropriate primary treatment. INTERVENTION: Radical hysterectomy performed by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS: Thirty patients each underwent LARH and ARH. The groups did not differ in terms of age, weight, disease stage, operating time, and hospital stay. Mean blood loss was 962 +/- 543 ml for ARH and 450 +/- 284 ml for LARH. No laparoscopic procedure was converted to laparotomy. There was no significant difference in intraoperative and postoperative complications. There was no significant difference in recurrence rates. CONCLUSION: LARH with pelvic lymphadenectomy does not increase recurrence rates and morbidity when performed by experienced endoscopists and oncologists.     

Laparoscopic detection of sentinel lymph nodes followed by lymph node dissection in patients with early stage cervical cancer

OBJECTIVE: The purpose of this study was to investigate the feasibility of sentinel node detection through laparoscopy in patients with early cervical cancer. Furthermore, the results of laparoscopic pelvic lymph node dissection were studied, validated by subsequent laparotomy. METHODS: Twenty-five patients with early stage cervical cancer who planned to undergo a radical hysterectomy and pelvic lymph node dissection received an intracervical injection of technetium-99m colloidal albumin as well as blue dye. With a laparoscopic gamma probe and with visual detection of blue nodes, the sentinel nodes were identified and separately removed via laparoscopy. If frozen sections of the sentinel nodes were negative, a laparoscopic pelvic lymph node dissection, followed by radical hysterectomy via laparotomy, was performed. If the sentinel nodes showed malignant cells on frozen section, only a laparoscopic lymph node dissection was performed. RESULTS: One or more sentinel nodes could be detected via laparoscopy in 25/25 patients (100%). A sentinel node was found bilaterally in 22/25 patients (88%). Histological positive nodes were detected in 10/25 patients (40%). One patient (11%) had two false negative sentinel nodes in the obturator fossa, whereas a positive lymph node was found in the parametrium removed together with the primary tumor. In seven patients (28%), the planned laparotomy and radical hysterectomy were abandoned because of a positive sentinel node. Bulky lymph nodes were removed through laparotomy in one patient, and in six patients only laparoscopic lymph node dissection and transposition of the ovaries were performed. These patients were treated with chemoradiation. In two patients, a micrometastasis in the sentinel node was demonstrated after surgery. Ninety-two percent of all lymph nodes was retrieved via laparoscopy, confirmed by laparotomy. Detection and removal of the sentinel nodes took 55 +/- 17 min. Together with the complete pelvic lymph node dissection, the procedure lasted 200 +/- 53 min. CONCLUSION: Laparoscopic removal of sentinel nodes in cervical cancer is a feasible technique. If radical hysterectomy is aborted in the case of positive lymph nodes, sentinel node detection via laparoscopy, followed by laparoscopic lymph node dissection, prevents potentially harmful and unnecessary surgery.     

Peritoneal carcinomatosis after laparoscopic radical hysterectomy for early-stage cervical adenocarcinoma

BACKGROUND: The risk of wound metastasis after laparoscopic management of early-stage cervical cancer is well known, but there are few data on peritoneal carcinomatosis of cervical adenocarcinoma. CASE: We report the first case of peritoneal carcinomatosis occurring in a woman with FIGO stage Ib1 cervical adenocarcinoma who underwent laparoscopic type III radical hysterectomy and bilateral pelvic lymphadenectomy (sentinel node procedure) followed by vaginal brachytherapy. A peritoneal recurrence was diagnosed 16 months after surgery and was treated with chemotherapy and laparotomy. CONCLUSION: Laparoscopy for cervical adenocarcinoma may carry a risk of peritoneal dissemination.