腹腔镜手术治疗子宫恶性肿瘤62例报告

目的探讨腹腔镜下子宫广泛切除和盆腹腔淋巴结切除治疗妇科恶性肿瘤的可行性。方法2003年2月-2005年8月，采用腹腔镜下子宫广泛切除和盆腔及腹主动脉周围淋巴结切除治疗62例经活检证实的早期妇科恶性肿瘤，其中子宫内膜癌26例，子宫颈癌36例。62例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，5例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61例腹腔镜下完成手术，1例术中静脉损伤出血中转开腹。手术时间165—265min，平均217min；术中出血量150—1200ml，平均260ml；切除淋巴结数13—23枚，平均17枚。1例发生膀胱损伤，镜下修补后恢复良好。术后发生尿潴留4例，淋巴囊肿5例。61例随访1—28个月，1例宫颈鳞腺癌Ⅱ。期术后3个月复发，放弃治疗4个月死亡；其余60例无复发。结论子宫恶性肿瘤腹腔镜下行子宫广泛切除和盆腹腔淋巴结切除术安全、可行。分期可靠、准确。     

腹腔镜下广泛全子宫切除加盆腔淋巴结清扫治疗子宫恶性肿瘤11例临床研究

目的:探讨腹腔镜广泛全子宫切除和盆腹腔淋巴结切除术治疗子宫恶性肿瘤的可行性及临床价值。方法:回顾分析我院行腹腔镜子宫广泛切除和盆腔淋巴结切除术治疗11例经活检证实的早期子宫恶性肿瘤患者的临床资料,其中子宫颈癌8例,子宫内膜癌3例,总结其手术时间、术中出血量、淋巴结切除数、手术并发症及近期预后情况。结果:11例均用腹腔镜完成手术,手术时间平均(298.2±40.5)min,术中平均出血(255.5±158.5)ml,平均淋巴结切除(12.3±3.0)枚,术中无脏器损伤,11例术后随访1～13个月,无死亡及复发病例。结论:腹腔镜广泛全子宫切除和盆腔淋巴结切除术治疗子宫恶性肿瘤安全、可行,有临床应用价值。     

腹腔镜广泛子宫切除并盆腔淋巴结清扫术治疗子宫恶性肿瘤护理体会

经腹广泛性子宫切除＋盆腔淋巴结清扫术一直是治疗早期宫颈癌的标准术式。自1992年Nezhat等首先为1例宫颈癌IA2患者施行腹腔镜广泛全子宫切除＋盆腔腹主动脉旁淋巴清扫术以来,一些妇科肿瘤学家开始探索行腹腔镜宫颈癌根治术的可行性。2007年3月至2008年3月我院施行11例腹腔镜子宫广泛切除加盆腔淋巴结清扫术。现报道如下。     

血管悬吊法腹腔镜腹主动脉及下腔静脉后淋巴结切除

目的 探讨血管悬吊法腹腔镜腹主动脉及下腔静脉后淋巴结切除的可行性和安全性.方法 2018年6月～2020年12月,对术前影像学提示或术中发现腹主动脉及下腔静脉周围淋巴结肿大的7例子宫内膜癌和8例卵巢癌行全面分期手术,悬吊腹主动脉及下腔静脉,完成腹腔镜腹主动脉及下腔静脉后淋巴结切除.结果 手术顺利.子宫内膜癌和卵巢癌中位...     

腹腔镜下广泛子宫切除加盆腔淋巴结清扫术(附30例报告)

目的:评价腹腔镜下广泛子宫切除加盆腔淋巴结清扫术治疗子宫颈癌和子宫内膜癌的实用价值,总结其优点及手术注意事项。方法:对12例子宫内膜癌、18例子宫颈癌施行腹腔镜下广泛子宫切除加盆腔淋巴结清扫术。结果:除1例中转开腹外,其余患者均在腹腔镜下完成手术,切除淋巴结19.5个(13~24个)。术中重要脏器损伤2例,发生率为6.67%。术后并发症发生率13.33%。子宫内膜癌术后复发率8.33%。子宫颈癌术后复发率5.56%。结论:腹腔镜下广泛子宫切除加盆腔淋巴结清扫术具有创伤小、术野清晰、并发症少、术后康复快等优点,并具有开腹手术的效果。     

腹腔镜下广泛性阴道旁组织切除术治疗全子宫切除术后阴道残端癌3例报告

目的探讨腹腔镜广泛性阴道旁组织切除及盆腔、腹主动脉旁淋巴结切除术在全子宫切除术后阴道残端癌治疗中应用。方法 2008年4月～2011年6月,3例全子宫切除术后阴道残端癌,行腹腔镜阴道残端肿物切除、广泛阴道旁组织切除、盆腔淋巴结清扫术,其中1例行腹主动脉旁淋巴结切除术。结果 3例手术均顺利,手术时间分别为330、487、327min,出血量200、150、100 ml,切除盆腔淋巴结26、20、30枚,例3切除腹主动脉旁淋巴结12枚,其中例1术后病理证实有盆腔淋巴结转移。术中无并发症发生。3例术后第2天均肠道功能恢复,术后14天拔除尿管,尿潴留2例,予重置尿管。3例术后随访48、14和10个月,未发现局部复发和全身转移。结论对全子宫切除术后阴道残端癌,行腹腔镜下阴道残端肿物切除、广泛性阴道旁组织切除术和盆腔淋巴结清扫术安全、有效,且疗效满意。     

腹腔镜手术治疗子宫恶性肿瘤13例报告

目的 探讨腹腔镜下开展子宫恶性肿瘤手术治疗的可行性。方法 对11例子宫内膜癌和2例子宫颈癌患分别施以腹腔镜下广泛全子宫切除加双侧附件切除术和广泛全子宫切除加双侧附件切除加盆腔淋巴结清扫术。结果 腹腔镜下广泛全子宫切除加双侧附件切除11例,平均手术时间为220min,术中出血量平均200ml;广泛全子宫切除加双侧附件切除加盆腔淋巴结清扫2例,平均术时240min。术中出血平均350ml。术中无一例脏器损伤,平均住院时间8天。结论 腹腔镜手术治疗早期子宫恶性肿瘤,有创伤小恢复快的优点,值得推广。     

腹腔镜手术治疗子宫恶性肿瘤近期疗效分析

目的探讨腹腔镜手术治疗子宫恶性肿瘤的可行性及近期疗效。方法2003年2月~2005年3月,我院采用腹腔镜下广泛全子宫切除和盆腔淋巴结切除治疗25例宫颈癌和24例子宫内膜癌,其中5例行选择性腹主动脉旁淋巴结切除术。结果除1例中转开腹外,48例均在腹腔镜下完成手术。手术时间(190±45)m in,术中出血量(172±99)m l,淋巴结切除数(17±6)个。手术并发症8例(8/49,16%),其中术中膀胱损伤1例,髂内静脉损伤1例,术后尿潴留3例,术后6个月膀胱阴道瘘1例,淋巴囊肿2例。随访42例,其中1~12个月21例,12~24个月17例,24~27个月4例,均未见复发。结论腹腔镜手术治疗子宫恶性肿瘤安全、可行,近期疗效显著。     

子宫颈癌的微创手术治疗现状与进展

子宫颈癌是最常见的女性生殖器官恶性肿瘤,经腹广泛性子宫切除+盆腔淋巴结切除术一直是治疗早期宫颈癌的标准术式.90年代以来,随着腹腔镜设备的改进,操作技术的不断熟练,以腹腔镜为主的相关微创技术逐渐用于子宫颈癌的治疗,其中腹腔镜下广泛性子宫切除术已逐渐应用于子宫恶性疾病的治疗,具有创伤小、术后康复快及病率低等优点.近年来,许多学者对腹腔镜下子宫颈癌的手术、分期进行了系列研究,初步证实用腹腔镜行广泛子宫切除和盆腔及腹主动脉旁淋巴结切除术效果同开腹手术,腹腔镜下同样能完成子宫颈癌的手术治疗和分期,长期随访结果相当.     

腹腔镜广泛子宫切除及盆腔淋巴结清扫术的临床体会

目的:总结腹腔镜广泛子宫切除及盆腔淋巴结清扫术的手术经验及并发症的预防。方法:回顾分析2010年3月至2011年6月为32例患者施行腹腔镜广泛子宫切除及盆腔淋巴结清扫术的临床资料。结果:32例患者中,1例术后9 d发生膀胱阴道瘘(迟发性电损伤所致);1例术毕查看尿袋,见气体充盈张力较大,证实膀胱损伤;余30例手术效果满意。结论:腹腔镜广泛子宫切除及盆腔淋巴结清扫术出血少,并发症少,术后康复快,安全可行,充分体现了妇科领域微创手术的优势。     

Indications and results of extemporaneous examination of pelvic lymph nodes in the surgical strategy of stage Ib or II cancers of the cervix uteri]

The aim of this study was to evaluate the accuracy of frozen section examination of lymph nodes and its place in the surgical management of early stage cervical cancer. This study was based on 80 patients with stage Ib (n = 76) or IIa (n = 4) invasive cervical carcinoma, with tumor size < 3 cm, treated by radical hysterectomy with pelvic lymphadenectomy with frozen section examination of pelvic lymph nodes. A total of 718 nodes were submitted to frozen section examination. Only one case of false-negative result was found (micrometastases). The sensitivity of frozen section examination in detecting metastatic nodes was 92.3%, its specificity was 100% and its negative predictive value was 97%. Frozen section diagnosis of pelvic nodes is a reliable procedure and should be carried out on obturator, external iliac and common iliac nodes. It should, therefore be performed in patients with early cervical carcinoma to avoid routine para-aortic lymphadenectomy.     

Complications of laparoscopic radical hysterectomy and lymphadenectomy for invasive cervical cancer: experience based on 317 procedures

Background This report presents the incidence of complications and conversions during laparoscopic radical hysterectomy and lymphadenectomy performed for invasive cervical carcinoma. The data are analyzed, and strategies to help prevent future complications are discussed. Methods From July 2000 to December 2005 at the authors’ institution, 317 laparoscopic radical hysterectomy and lymphadenectomy procedures for invasive cervical carcinoma were performed. The authors reviewed the database of patients who underwent laparoscopic radical hysterectomy and lymphadenectomy to examine complications and analyze factors associated with conversion to an open surgical procedure. Results All but four surgical procedures were laparoscopically completed. Pelvic lymphadenectomy was performed for all the remaining 313 patients, 143 of whom underwent paraaortic lymphadenectomy. Major and minor intraoperative complications occurred for 4.4% (n = 14) of the patients. The overall conversion rate was 1.3% (n = 4), including 3 emergencies and 1 elective conversion. Seven patients had vessel injuries, five of which were repaired or treated laparoscopically. One left external iliac vein required laparotomy, and one patient underwent laparotomy to control bleeding sites. Operative cystotomies occurred in five patients, which were repaired laparoscopically. Two patients underwent laparotomy because of hypercapnia and ascending colon injury. Postoperative surgery complications occurred in 5.1% (n = 16) of the patients, including 5 patients with ureterovaginal fistula, 4 with vesicovaginal fistula requiring reoperation, 1 with ureterostenosis treated by placement of a double-J ureteral stent, and 6 with bladder dysfunctions (retention) that exhibited complete resolution within 3 to 6 months by intermittent training and catheterization. Conclusions Laparoscopic radical hysterectomy and lymphadenectomy is becoming a routine procedure in the armamentarium of many gynecologists. Complications unique to laparoscopy do exist, but they decrease with repeated training of the procedure and gradually enriched experiences.     

The Outcome of Laparoscopic Radical Hysterectomy and Lymphadenectomy for Cervical Cancer: A Prospective Analysis of 295 Patients

Objectives  Cervical carcinoma is likely to become one of the most important indications for laparoscopic radical surgery. The laparoscopic technique combines the benefits of a minimally invasive approach with established surgical principles. In our institution, the laparoscopic radical hysterectomy and transperitoneal approach for lymphadenectomy have become the standard techniques for invasive cervical cancer. We report the indications, techniques, results, and oncological outcome in a single center experience. Methods  Between February 2001 and June 2007 we performed laparoscopic radical hysterectomies for cervical cancer in 295 patients. Their initial techniques, operation data, complications, postoperative course, oncological outcome, and survival were evaluated. Results  Out of 295 procedures, 290 were successful. Para-aortic lymphadenectomy was performed in 156 patients (52.9%), and pelvic lymphadenectomy was performed in all 295 patients. The median blood loss was 230 mL (range, 50–1200 mL). The mean operation time was 162 min (range, 110–350), which included the learning curves of 3 surgeons. In 5 cases (1.7%), conversion to open surgery was necessary due to bleeding (3 cases), bowel injury (1 case), and hypercapnia (1 case). Other major intraoperative injuries occurred in 12 patients (4.1%). Positive lymph nodes were detected in 80 cases (27.1%), lymphovascular space invasion in 54 cases (18.3%), and surgical margins were negative for tumor in all patients. The mean hospital stay was 10.3 days. Postoperative complications occurred in 10.8% patients, ureterovaginal fistula in 5 cases, vesicovaginal fistula in 4, ureterostenosis in 3 cases, deep venous thrombosis in 9 cases, lymphocyst in 4 cases, lymphedema in 5 cases, and 1 case with trocar insertion site metastasis. Other medical problems included 47 cases (15.9%) of bladder dysfunction and 62 cases (21.0%) of rectum dysfunction or constipation. The median follow-up was 36.45 months (range, 8–76 months). Recurrences or metastasis occurred in 48 patients (16.3%). Of these patients, 43 (14.6%) have died of their disease, and 5 (1.7%) are alive with disease. The overall disease-free survival was 95.2% for Ia, 96.2% for Ib, 84.5% for IIa, 79.4% for IIb, 66.7% for IIIa, and 60.0% for IIIb. Conclusion  Laparoscopic radical hysterectomy is a routine, effective treatment for patients with Ia2–IIb cervical carcinoma. With more experience it is envisaged that IIb stage patients can be managed safely offering all the benefits of minimal surgery to the patients. Although no long-term follow-up is available, our follow-up data for up to 76 months confirm the effectiveness of laparoscopic radical hysterectomy in terms of surgical principles and oncological outcome.     

Results of Hysterectomy in Patients With Bulky Residual Disease at the End of Chemoradiotherapy for Stage IB2/II Cervical Carcinoma

Background We assessed the clinical outcome after hysterectomy in patients with bulky residual disease after chemoradiotherapy for stage IB2/II cervical carcinoma.Methods Subjects were 10 patients who had bulky (>2 cm) residual disease in the cervix after external radiotherapy (45 Gy) combined with concomitant chemotherapy (cisplatin 40 mg/m²/week) and uterovaginal brachytherapy (15 Gy).Results Extrafascial hysterectomy was performed in three patients, type II radical hysterectomy was performed in six patients, and pelvic exenteration was performed in one patient. Pelvic lymphadenectomy was performed in eight patients, and para-aortic lymphadenectomy was performed in eight. Five patients had nodal involvement (pelvic nodes in four and para-aortic nodes in four), and six had lymphovascular space involvement. Surgical margins were free in nine patients. Seven patients developed grade 2 (n = 3) and/or grade 3 (n = 4) complications. The median duration of follow-up after surgery was 22 months (range, 1–37 months). With follow-up available in nine patients, seven relapsed, and only two remained disease free.Conclusions This series confirms the high rate of nodal spread in patients with bulky residual cervical disease after chemoradiotherapy. Furthermore, patients who underwent hysterectomy had a high complication rate. Only two patients are alive and disease free. The results of surgery are disappointing; surgery does not seem to improve the survival of these patients.Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.     

Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer

BACKGROUND AND OBJECTIVES: To compare intraoperative, pathologic and postoperative outcomes of robotic radical hysterectomy (RRH) to total laparoscopic radical hysterectomy (TLRH) in patients with early stage cervical carcinoma. METHODS: We prospectively analyzed cases of TLRH or RRH with pelvic lymphadenectomy performed for treatment of early cervical cancer between 2000 and 2008. RESULTS: Thirty patients underwent TLRH and pelvic lymphadenectomy for cervical cancer from August 2000 to June 2006. Thirteen patients underwent RRH and pelvic lymphadenectomy for cervical cancer from April 2006 to January 2008. There were no differences between groups for age, tumor histology, stage, lymphovascular space involvement or nodal status. No statistical differences were observed regarding operative time (323 vs 318 min), estimated blood loss (157 vs 200 mL), or hospital stay (2.7 vs 3.8 days). Mean pelvic lymph node count was similar in the two groups (25 vs 31). None of the robotic or laparoscopic procedures required conversion to laparotomy. The differences in major operative and postoperative complications between the two groups were not significant. All patients in both groups are alive and free of disease at the time of last follow up. CONCLUSION: Based on our experience, robotic radical hysterectomy appears to be equivalent to total laparoscopic radical hysterectomy with respect to operative time, blood loss, hospital stay, and oncological outcome. We feel the intuitive nature of the robotic approach, magnification, dexterity, and flexibility combined with significant reduction in surgeon's fatigue offered by the robotic system will allow more surgeons to use a minimally invasive approach to radical hysterectomy.     

Urologic complications of laparoscopic radical hysterectomy and lymphadenectomy

Introduction and hypothesis

The purpose of this study was to evaluate the intra- and postoperative urologic complications and management in patients with cervical or endometrial cancer treated with laparoscopic radical hysterectomy and lymphadenectomy.

Methods

We retrospectively reviewed the medical records of 146 patients with cervical or endometrial cancer who underwent total laparoscopic radical hysterectomy with lymphadenectomy between August 2002 and April 2011. The intra- and postoperative urologic complications were analyzed.

Results

Double ureteral stents were inserted prophylactically in 13 patients (8.9?%), 2 of whom had postoperative urologic complications. Nine patients (6.2?%) had postoperative urologic complications. Of four patients with ureterovaginal fistulas, two were treated conservatively with cystoscopic placement of ureteral stents and two underwent ureteroneocystostomies. Vesicovaginal fistulas occurred in two patients, both of whom underwent vesicovaginal fistula repairs. One patient noted to have a bladder injury intraoperatively had a laparoscopic repair, and one patient noted to have a ureteral injury postoperatively was treated conservatively with cystoscopic placement of ureteral stents.

Conclusions

Iatrogenic lower urinary tract injuries during laparoscopic radical hysterectomy are relatively common complications. Intraoperative prophylactic ureteral stent insertion and the early detection of urologic complications postoperatively is advised for patients who undergo laparoscopic radical hysterectomies.     

腹腔镜广泛子宫切除术641例并发症分析

目的:探讨腹腔镜广泛子宫切除术后并发症的发生原因及处理方法.方法:回顾性分析2006年1月-2011年1月在解放军总医院妇产科临床诊断为宫颈癌和子宫内膜癌并行腹腔镜广泛子宫切除术的641例患者手术并发症的发生和处理情况,并与963例行开腹广泛子宫切除术的宫颈癌和子宫内膜癌患者的术后并发症发生情况进行比较.结果:行腹腔镜...     

腹腔镜子宫颈癌根治术与开腹手术的对比研究

目的:对比分析腹腔镜子宫颈癌根治术与开腹手术的临床疗效及安全性。方法:回顾分析2004年2月至2010年2月46例腹腔镜子宫颈癌根治术患者(腹腔镜组)的临床资料,并随机抽取同期46例开腹手术(开腹组)作为对照组,对比分析两组患者手术时间、术中出血量及输血量、淋巴结数量、术中术后并发症发生率、患者住院时间、术后复发情况等。结果:腹腔镜组手术时间、术中出血量及住院时间少于开腹组,差异有统计学意义(P<0.05);两组淋巴结切除数量差异无统计学意义。腹腔镜组术中发生血管损伤1例,术后并发症(如尿潴留、淋巴囊肿、下肢静脉血栓)发生率为26.09%;开腹组术中发生膀胱损伤、输尿管损伤各1例,术后并发症发生率为32.61%;差异无统计学意义。术后随访16～60个月,2例复发。结论:腹腔镜宫颈癌根治术用于宫颈癌的手术分期与治疗具有分期准确、患者创伤小、术中出血少、术后康复快、并发症少等优点,具有极大的临床应用前景。