腹腔镜手术治疗早期低危型卵巢恶性肿瘤的价值

目的探讨腹腔镜手术治疗早期低危型卵巢恶性肿瘤的价值。方法对10例卵巢恶性肿瘤患者,在腹腔镜下行全子宫切除+双附件切除+卵巢动静脉高位结扎+盆腔淋巴结清扫+大网膜切除+阑尾切除,并将同期11例施行经腹同类手术的卵巢恶性肿瘤患者作为对照组(开腹组)。就两组手术的手术时间、术中出血量、术后恢复情况和切除的盆腔淋巴结的数目进行比较。结果手术时间腹腔镜组为298min±60min,开腹组为182min±43min,两者比较P<005;术中出血量腹腔镜组为280ml±156ml,开腹组为346ml±170ml,两者比较P<005;切除淋巴数目腹腔镜组为25个±5个,开腹组为27个±6个,两者比较P>005;术后病率腹腔镜组为200%,开腹组为727%,两者比较P<001;48h下床活动腹腔镜组为7例,开腹组为1例,两者比较P<005;腹腔镜下手术发生1例右侧闭孔神经损伤,在腹腔镜下缝合成功。结论腹腔镜下可施行早期低危型卵巢恶性肿瘤手术包括全子宫+双附件切除+卵巢动静脉高位结扎+盆腔淋巴结清扫+大网膜切除+阑尾切除的全部过程,具有术中出血少、术后病率低、术后恢复快的优点。

Evaluation of laparoscopic surgery in the early stage-malignant tumor of ovary with lower risk

OBJECTIVE: To evaluate the laparoscopic operation for early ovarian malignant tumor with low risk. METHODS: Ten patients with ovarian malignant tumor who underwent laparoscopic total hysterectomy, pelvic lymph nodes dissection, bilateral adnexectomy, ovarian aortic and vein high ligation, omentectomy, and additional appendectomy. Eleven patients with the same diagnosis who underwent operation by laparotomy were served as control group. The operation time, intraoperative blood loss, number of pelvic lymph nodes excised, and postoperative recovery were analyzed retrospectively. RESULTS: Frozen section method during operation proved the diagnosis of ovarian malignant tumor and cytological examination proved a negative result of the peritoneal irrigation liquid. The operation time was 298 min +/- 60 min for the laparoscopy group and 182 min +/- 43 min for the laparotomy group (P < 0.05). The intraoperative blood loss was 280 ml +/- 156 ml for the laparoscopy group and 346 ml +/- 170 ml for the laparotomy group (P < 0.05). The number of pelvic lymph node resected was 25 +/- 5 and 27 +/- 7 for the laparoscopy group and laparotomy group respectively (P > 0.05). The postoperative illness rate was 20.0% and 72.7% for the laparoscopy group and laparotomy group respectively (P < 0.01). Seven patients and 1 case in the laparoscopy group and laparotomy group left their beds 48 hours after operation (P < 0.05). The right obtuator nerve was injured and was sutured on 1 patient in the laparoscopy group. CONCLUSION: The whole procedure of total hysterectomy, bilateral adnexectomy, pelvic lymph node dissection, ovarian aortic and vein high ligation, omentectomy, and additional appendectomy may be performed under laparoscope in the treatment of early stage ovarian malignant tumor with lower risk. The laparoscopic operation has the advantage of less intraoperative bleeding, less morbidity and rapid recovery.