机器人辅助腹腔镜宫颈癌转移淋巴结切除经验及思考

<正>淋巴结转移是宫颈癌转移主要途径,因此淋巴结切除在宫颈癌手术中占有重要地位,与卵巢癌、子宫内膜癌手术相比,宫颈癌淋巴结清扫术是宫颈癌手术不可或缺的(IA1期无LVSI除外);保留生育功能的宫颈癌广泛宫颈切除术,淋巴结切除排除淋巴结转移决定着能否保留生育功能;淋巴结清扫在宫颈癌精准放疗中也占有一席之地;妊娠合并宫颈癌患者如果保留胎儿,淋巴结清扫判断淋巴结状态是可采用的手段之一。淋巴结切除可通过开腹、普通腹腔镜及机器人辅助腹腔镜来完成,腹腔镜     

机器人与传统腹腔镜手术治疗早期上皮性卵巢癌的临床对比研究

目的:对比分析机器人与传统腹腔镜手术治疗早期上皮性卵巢癌的优缺点及预后价值。 方法:收集 2016 年 5 月至 2020 年 11 月于郑州大学第一附属医院治疗的 73 例早期(FIGOⅠ ~ Ⅱ期) 上皮性卵巢癌患者的临床资料,其中机器人辅助下腹腔镜手术 30 例(机器人组),传统腹腔镜手术 43 例(腹腔镜组)。 比较两组术中、术后相关指标和远期疗效。 结果:①两组患者均顺利完成手术, 无中转开腹。 与腹腔镜组比较,机器人组的手术时间长、术中出血量少、术中切除淋巴结数多、手术 费用较高、术后 24 小时腹腔引流量少,差异均有统计学意义(P < 0. 05);②对机器人助手(8 人)调 查发现:操作便利性满意(87. 5% )、器械连接与装配满意(75. 0% )及学习难度满意(87. 5% ),与主刀 配合时的难易度及手术系统转运满意率均为 62. 5% ,而舒适度的满意率为 50. 0% ;③在随访期内,两组 患者的复发率及无进展生存期比较,差异无统计学意义(P >0. 05)。 结论:机器人辅助腹腔镜全面分期 手术治疗早期上皮性卵巢癌具有减少术中出血量、术中切除淋巴结多、腹腔引流量少的优势,但存在助 手配合有难度、花费高等缺点,随着技术的革新,合理选择患者的条件下,机器人手术治疗早期上皮性 卵巢癌具有优越性。     

PAX1甲基化检测对细胞学异常(ASCUS、LSIL和ASC-H)患者的分流作用

目的:探讨配对盒基因家族1(PAX1)甲基化检测在细胞学异常女性中的分流作用。方法:选取212例宫颈细胞学(TCT)诊断为意义未明的不典型鳞状细胞(ASCUS)、不除外高度鳞状上皮内病变(ASC-H)、低度鳞状上皮内病变(LSIL)的病例进行PAX1甲基化检测和高危HPV检测,进行阴道镜检查和宫颈活检。以组织病理结果为金标准,比较PAX1和高危HPV检出HSIL+(HSIL和宫颈鳞癌)效能。结果:LSIL组(慢性宫颈炎和LSIL)的PAX1阳性率为7.25%(10/138),显著低于HSIL+组86.49%(64/74)(P<0.05)。LSIL组的HPV阳性率为69.57%(96/138)显著低于HSIL+组89.19%(66/74)(P<0.05)。PAX1诊断HSIL+的敏感性(86.49%)与高危HPV(89.19%)相比,无显著差异(P>0.05);特异性、准确性和AUC(92.75%、90.56%、0.896)均显著高于高危HPV(30.43%、50.94%和0.598)(P均<0.05)。使用PAX1甲基化代替HPV检测对细胞学进行分流时,阴道镜转诊率可降至34.91%。细胞学结果分别为ASCUS、LSIL、ASC-H时,PAX1诊断HSIL+准确性(84.21%、91.30%、100.00%)均显著高于高危HPV(63.15%、34.78%、63.64%)(P均<0.05)。结论:PAX1基因的甲基化具有较高的灵敏度和特异度,在细胞学异常(ASCUS、LSIL、ASC-H)女性中通过PAX1甲基化检测分流可提高对HSIL+的检出率,其诊断效能优于高危HPV检测,并且能降低一定的阴道镜转诊率。     

165例卵巢恶性肿瘤不全分期术后行再分期手术必要性的临床初探#br#

Objective?To investigate the necessity of the re-staging operation after incomplete staging of epithelial cancer, ovarian malignant germ cell tumor and sex cord stromal tumor. Methods?A retrospective analysis was made on 165 ovarian cancer patients with surgical stageⅠA~ⅠC after incomplete staging operation who underwent re-staging operation in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2021. There were 85 cases in the epithelial carcinoma group, 31 cases in the malignant germ cell tumor group and 49 cases in the malignant sex cord stromal tumor group. Results?The rate of benefit from re-staging operation (surgical-pathological staging upgraded after re-staging operation) was 36.47% (31/85) in the epithelial cancer group, which was significantly higher than that in the germ cell tumor group (9.68%, 3/31) and sex cord stromal tumor group (4.08%, 2/49), the difference was statistically significant (P<0.05). The rates of benefit from re-staging operation among epithelial cancer, germ cell tumor and sex cord stromal tumor patients who had no residual impression tumor in incomplete staging operation are 33.33%(27/81), 3.44%(1/29) and 0%(0/47), which are significantly lower than that in the patients who had residual impression tumor in incomplete staging operation (P<0.05); The rates of benefit from re-staging operation among epithelial cancer, germ cell tumor and sex cord stromal tumor patients who had no positive imaging findings before re-staging are 34.15%(28/82), 3.44%(1/29) and 2.08%(1/48), which are significantly lower than that in the patients who had positive imaging findings before re-staging (P<0.05). Conclusion?The epithelial ovarian carcinoma with early surgical stage in incomplete staging operation should be treated with re-staging surgery after incomplete staging surgery; When there are residual tumor in incomplete staging operation or positive imaging findings before re-staging in the early surgical stage germ cell tumors and in the early surgical stage sex cord stromal tumors, it is necessary to perform re-staging surgery for them.     

开腹与腹腔镜下输卵管吻合术回顾性队列研究及术后妊娠影响因素分析#br#

【Abstract】?Objective?To evaluate the safety and effectiveness of laparotomic and laparoscopic tubal anastomosis, and evaluate the influencing factors of pregnancy rate. Methods?The clinical data of 356 ligation patients who underwent tubal anastomosis in the First Affiliated Hospital of Zhengzhou University from March 2012 to October 2017 were analyzed retrospectively, including 85 cases of laparotomy and 271 cases of laparoscopy. The differences of perioperative status and postoperative pregnancy rate between the two groups were analyzed, and the independent influencing factors of postoperative pregnancy rate were analyzed. Results?①There was no significant difference in operation time, postoperative fever and exhaust time between the two groups (P>0.05), but laparoscopic bleeding was less[(18.1±12.1) ml, (33.4±22.1) ml], and the pain score was lower[(3.6±0.9), (4.5±0.9) score], duration of hospital stay was shorter[(5.9±0.6) d, (7.1±0.7) d](P<0.05). 2 cases of laparotomic group had abdominal wall incision infection, cases of laparoscopic group all healed well. The cost of laparotomic group was lower than that in laparoscopic group[(9 524±881), (12 903±1 162) yuan](P<0.05).② There was no significant difference in the patency rate of intraoperative anastomosis, residual tube length and ectopic pregnancy rate between the two groups (P>0.05). The uterine pregnancy rate two years after anastomosis was higher in laparoscopic group (76.4%) than in laparotomic group(61.2%)(P<0.05). The postoperative gestation time of the laparoscopic group was (7.6±4.9) months, and the postoperative gestation time of the open group was (8.3±5.3) months, with no statistically significant difference(P>0.05).③ Anastomotic procedure (OR=1.847, 95%CI: 1.028~3.320, P=0.040), age (OR=3.673, 95%CI: 1.690~7.984, P=0.001), multiple pelvic operation history (OR=3.092, 95%CI: 1.650~5.796, P=0.000), and length of residual tube (OR=4.716, 95%CI: 2.552~8.714, P=0.000) were independent factors influencing intrauterine pregnancy rate after anastomosis. There was no significant correlation between body mass index (BMI), length of ligation, method of ligation and site of ligation and pregnancy rate. Conclusion?Compared with open surgery, laparoscopic tubal anastomosis is a better treatment option for patients with tubal ligation. Anastomosis mode, age, history of multiple pelvic surgeries and length of remaining fallopian tubes were the influencing factors of pregnancy rate after anastomosis.     

输液港、外周静脉穿刺中心静脉置管和留置针用于妇科恶性肿瘤化疗的队列研究

目的比较植入式静脉输液港(IVAP)、经外周静脉穿刺中心静脉置管(PICC)和外周静脉通路(PIVA)在妇科恶性肿瘤静脉化疗中的应用效果。方法收集2014年11月至2016年12月在郑州大学第一附属医院进行静脉化疗的妇科恶性肿瘤患者576例,按输液途径分为IVAP组、PICC组和PIVA组,对三组首次穿刺成功率、并发症、患者和护士满意度进行比较。结果 PIVA组首次穿刺成功率(92.4%,3 050/3 300)低于IVAP组(98.8%,158/160)(P=0.003)和PICC组(96.5%,193/200)(P=0.032);IVAP组置管时首次穿刺成功率(98.8%,158/160)与PICC组(96.5%,193/200)比较,差异无统计学意义(χ~2=1.846,P=0.174)。IVAP组总并发症发生率(3.1%,5/160)明显低于PICC组(11.0%,22/200)P=0.005)和PIVA组(14.4%,31/216)(P=0.000);PICC组总并发症发生率与PIVA组比较,差异无统计学意义。IVAP组有96.3%(154/160)的患者认为输液港方便了治疗,高于PICC组(χ~2=7.920,P=0.005)和PIVA组(χ~2=69.501,P=0.000);在洗澡、游泳、做家务方面,PICC组有46.5%(93/200)的患者受到了影响,多于IVAP组(3.8%,6/160)和PIVA组(12.0%,26/216)(P均0.05)。IVAP组护士的满意度评分【(92.7±4.46)分】明显高于PICC组【(81.3±4.74)分】(P=0.000)和PIVA组【(65.3±4.95)分】(P=0.000);PICC组护士的满意度评分【(81.3±4.74)分】高于PIVA组【(65.3±4.95)分】(P=0.000)。结论 IVAP和PICC置管首次穿刺成功率高,能明显减轻患者反复穿刺的痛苦;尤其是IVAP,并发症发生率低,患者及护士满意度高,值得在妇科恶性肿瘤静脉化疗中推广。     

脉管平滑肌瘤8例临床分析

目的 探讨脉管平滑肌瘤的临床特点、诊断、治疗和预防.方法 回顾分析2012年6月至2016年6月郑州大学第一附属医院收治的8例脉管平滑肌瘤病患者的资料,总结其临床特点,结合国内外相关文献,分析发病特点及治疗方法.结果 术前仅有1例彩超提示可疑,确诊主要依据术中所见及术后病理,随访结局良好.结论 脉管平滑肌瘤发病率低,临床表现无特异性,术前无特异的辅助检查明确诊断,主要依靠术中所见及病理;治疗首选手术.术后需严密随访.     

机器人辅助腹腔镜与传统腹腔镜治疗女性原发性盆腔腹膜后肿瘤疗效比较北大核心CSCD

目的探讨与传统腹腔镜相比,达芬奇机器人辅助腹腔镜在女性原发性盆腔腹膜后肿瘤(PPRT)切除术中的优势及安全性。方法回顾性收集2017年1月至2021年10月在郑州大学第一附属医院接受手术治疗的女性PPRT患者病例资料,包括机器人组28例,腹腔镜组63例。对比两组患者的一般资料、手术相关资料、并发症及预后。结果机器人组与腹腔镜组相比,肿瘤手术时间长(191.5min vs.156.0min)、总花费高(62586.1元vs.34669.5元)、术中并发症发生率低(7.1%vs.25.4%)(P<0.05);两组患者术中出血量、中转开腹率、术后排气时间、术后拔管时间、术后住院时间、复发率等差异均无统计学意义(P>0.05)。机器人组初次手术失败或复发性肿瘤5例患者手术均顺利完成;腹腔镜组2例此类患者1例中转开腹手术,1例患者因出血多给予输血治疗。结论达芬奇机器人辅助腹腔镜治疗女性PPRT虽然手术时间长、住院费用高,但可减少手术并发症,具备一定的优势。对于初次手术失败或复发性肿瘤患者是一种更好的治疗选择。     

基于倾向性评分匹配方法探讨子宫腺肌病患者行子宫全切除术前使用GnRH-a预处理的价值

目的探讨子宫体积≥孕12周且合并中～重度贫血的子宫腺肌病患者行子宫全切除术前使用促性腺激素释放激素激动剂(GnRH-a)预处理的价值。方法回顾性分析2018年1月至2023年3月在郑州大学第一附属医院行子宫全切除术的子宫腺肌病患者689例的临床资料, 所有患者初诊子宫体积≥孕12周且合并中～重度贫血。根据术前用药情况分为研究组(127例)和对照组(562例), 研究组术前行GnRH-a预处理3个疗程后再手术, 对照组直接手术。采用SPSS 26.0软件对两组患者通过倾向性评分匹配进行1∶1匹配, 匹配变量包括年龄、体重指数、孕次、产次、盆腹腔手术史、月经周期、经期、痛经评分、初诊癌相关抗原125(CA125)水平、初诊子宫体积、初诊血红蛋白含量。对比研究组患者GnRH-a用药前后的痛经评分、子宫体积、血红蛋白含量、CA125水平, 并比较两组患者的手术时间、术中出血量、术后白细胞计数、围手术期输血例数、术后病率例数、住院时间及总费用。结果经倾向性评分匹配, 最终研究组和对照组各119例患者纳入本研究。研究组患者注射GnRH-a前、后, 其痛经评分[分别为(7.4±1.7)、(5.6±1...