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。

Clinical evaluation of laparoscopic radical hysterectomy with pelvic and para-aortic lymphadenectomy in patients with cervical cancer

OBJECTIVE: To evaluate the effective, results and complications in patients with cervical cancer who consented to undergo laparoscopic radical hysterectomy and retroperitoneal lymphadenectomy. METHODS: In 57 consecutive patients with stage Ia to IIb cervical cancer, laparoscopic radical hysterectomy and lymphadenectomy were performed. Forty-eight patients had squamous cell carcinomas, 7 patients had adenocarcinomas, and 2 patients had adenosquamous carcinomas of the cervix. RESULTS: All but 2 surgical procedures were completed laparoscopically. The average operative time was 186 min (150 - 320 min). The average blood loss was 168 ml (120 - 700 ml). Average numbers of pelvic and paraaortic lymph nodes removed were 18.6 (12 - 23) and 8.2 (6 - 12), respectively. Eight patients (14.0%) had positive lymph nodes. All surgical margins were macroscopically negative. Operative cystotomies occurred in 2 patients and one patient with venous injuries were repaired laparoscopically. Two other patients underwent laparotomy to control bleeding or repair ascending colon. After surgery, patients passed gas in 2.3 days and self-voided in 10.2 days on average. Follow-up has been provided every 3 months. There have been 3 cases of recurrences, one patient uncontrolled, and one patient ureteral constriction. Three patients have retention of urine. CONCLUSIONS: Laparoscopic radical hysterectomy and lymphadenectomy can be successfully completed in patients with cervical cancer with acceptable operation complications, a less injury and recovery time, and may become preferred for treating early cervical cancer.