腹腔镜联合阴式手术治疗早期子宫恶性肿瘤的临床价值

目的探讨腹腔镜盆腔淋巴切除 阴式广泛全子宫切除术(LPL VRH)治疗早期子宫恶性肿瘤的临床价值。方法2003年8月至2007年12月,选择11例早期子宫颈癌和8例子宫内膜癌的患者行LPL VRH治疗(研究组),选取同时入院接受开腹子宫广泛切除 淋巴切除术治疗早期子宫颈癌11例、子宫内膜癌8例为对照组,对其手术情况、手术时间、术后并发症、术中出血量、淋巴结切除数目、术后病率进行比较。结果研究组19例中18例成功手术,1例因淋巴结切除困难中转开腹。研究组与对照组在术中出血[(321.08±284.36)mL,(513.62±237.23)mL]、术后胃肠恢复时间(1.5d,4.5d)、术后下床活动时间(2d,7d),两组间比较差异有统计学意义(P<0.05)。而两组在手术时间、术中清除淋巴结数、术后尿潴留、尿失禁、淋巴囊肿及术后复发等指标上差异无统计学意义(P>0.05)。结论LPL VRH可作为早期子宫恶性肿瘤手术治疗方法之一,近期效果良好,远期疗效有待进一步观察。

Clinical analysis of 19 patients with early stage of malignant tumors treated by combined laparoscopic surgery with vaginal hysterectomy

Objective To analyze the practical value of LPL VRH(laparoscopic assisted lymphadenectomy and vaginal radical hysterectomy)treatment for early stage of malignant tumors.Methods A retrospective study of 11 cases of cervical carcinoma and 8 cases of endometrial carcinoma was done,which were treated by LPL VRH from Aug.2003 to Dec.2007.Make a comparison on the operation,operative time,postoperative complications,bleeding volume,the number of lymph node dissected,and postoperative morbidity with another 11 cases of cervical carcinoma and 8 cases of endometrial carcinoma,which were all treated by L VE(lymphadenectomy laparoscopic extensive) during the same period.Result In the 19 cases treated by LPL VRH,18 cases were successful,and only one converted to L VE because of the difficulty during dissecting the lymph node.There were significant differences(P<0.05) between the two groups in the aspects of bleeding,postoperative urinary retention,postoperative recovery of gastrointestinal function and the time to get out of bed.However,there were no significant differences(P>0.05)between them in the aspects of operation time,the number of the removed lymph nodes,urinary incontinence,lymphocele and the recurrence in the next five years after surgery.Conclusion LPL VRH can be used as a surgical treatment for early uterine cancer.Its recent results are good,and the long-term effect needs to be further studied.