腹腔镜广泛子宫切除和盆腔淋巴结切除术治疗子宫颈癌237例临床分析

目的探讨腹腔镜广泛子宫切除术治疗子宫颈癌的可行性、安全性、临床疗效、并发症和远期生存率。方法收集第三军医大学西南医院2000年9月至2006年7月期间，施行腹腔镜下广泛子宫切除术加盆腔淋巴结切除术治疗Ⅰa～Ⅱb期的子宫颈癌患者237例，并对其临床资料和随访情况进行回顾性分析。结果腹腔镜平均手术时间（209．7±53．8）min，术中平均出血量（316．5±174．4）ml，术后肠道功能恢复时间为（2．5±0．6）d。术后近期并发症：输尿管阴道瘘5例，膀胱阴道瘘3例，输尿管狭窄2例，深静脉栓塞9例，淋巴囊肿4例，1例腹壁切口处转移；远期并发症：膀胱功能障碍47例，直肠功能障碍56例。复发率8．4％，转移率7．6％，死亡率13．5％。患者总体1年、3年和5年生存率分别是95．6％、86．90和80．4％，中位生存期为76个月。结论腹腔镜广泛子宫切除加盆腔淋巴结切除术治疗宫颈癌是安全、可行的，远期疗效良好，可以作为子宫颈癌手术治疗的选择方式之一。

Clinical analysis of 237 cases of laparoscopic radical hysterectomy and lymphadenectomy for cervical cancer

Objective To investigate the probability, security, clinical effect, complication and survival rate of cervical cancer operated by laparoscopic radical hysterectomy and pelvic lymph node dissection. Methods A retrospective analysis for the cases with Ⅰa-Ⅱb cervical cancer operated by taparoscopy in Southwest Hospital from September 2000 to July 2006 were conducted. The clinical data and follow- up results were also reviewed. Results The mean operative time and blood loss were （209.7 ± 53.8） min vs （316.5 ± 174.4） ml, respectively. The time of bowel function recovery was （2.5±0. 6） d. The postoperative complications were included： 5 cases of ureterovaginal fistula, 3 cases of vesicovaginal fistula, 2 cases of ureterostenosis, 9 cases of deep venous thrombosis, 4 cases of lymphocyst, 1 case with trocar insertion site metastasis. Long-term complications were included： 47 cases of bladder dysfunction and 56 cases of rectum dysfunction. Recurrence rate was 8.4% and metastasis rate was 7.6%. 32 patients died. The survival rate of 1 year, 3 - year, 5 - year of the patients was 95.6%, 86.9%, 80.4%, respectively. The median survival time was 76 months. Conclusions Laparoscopic surgery for cervical cancer is safe, feasible and better long term effect. Laparoscopic radical hysterectomy is one of the selective methods for treatment of cervical cancer.