单孔腹腔镜广泛子宫切除盆腔淋巴结清扫治疗宫颈癌:一项单中心的初步研究

目的 探讨单孔腹腔镜广泛子宫切除盆腔淋巴结清扫治疗早期宫颈癌的可行性、安全性和短期临床结局.方法 2016年10月至2017年3月前瞻性纳入第三军医大学西南医院妇产科诊断为宫颈癌的患者,行单孔腹腔镜广泛子宫切除+盆腔淋巴结清扫术.统计患者人口学特征、临床肿瘤学结局和围手术期效果.结果 27例患者尝试手术,26例成功完成(96％),1例因术中探查合并Ⅳ期子宫内膜异位症而中转为多孔腹腔镜手术.患者中位年龄46岁,体质量指数为22.1 kg/m2,中位手术时间237 min,术中失血量平均186 mL.2例术中血管损伤,1例膀胱损伤,均在术中单孔腹腔镜下完成修补.平均盆腔淋巴结清扫数目21枚,手术切缘病理学检查均为阴性.1例患者因2枚盆腔淋巴结转移,术后进行化疗+放疗;7例合并中危因素患者,术后进行放疗.结论 具有丰富的妇科肿瘤腹腔镜手术经验的医生熟练掌握单孔腹腔镜手术技术的情况下,采用单孔腹腔镜手术是进行广泛子宫切除盆腔淋巴结清扫手术是可行的.

Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy for cervical cancer: a single-center trial

Objective To investigate the feasibility,safety,and short-term outcomes of laparoendoscopic single-site surgery radical hysterectomy with pelvic lymphadenectomy (LESS-RH/PLND) in treatment of cervical cancer.Methods Cervical cancer patients diagnosed and treated with LESS-RH/PLND in Southwest Hospital from October 2016 to March 2017 were prospectively enrolled in this study.The demographic data,and clinical,pathological and peri-operative outcomes were analyzed.Results Twentyseven women were recruited and attempted for LESS-RH/PLND.Twenty-six (96％) underwent the procedure successfully,and 1 patient was converted to 3-port laparoscopy due to stage Ⅳ endometriosis.Their median age was 46 years,and body mass index was 22.1 kg/m2.Their median operation time was 237 min and intraoperative blood loss was 186 mL.Two cases of large veins lacerations and one of bladder injury occurred during operation,and all were sutured promptly under a laparoendoscope.The median number of pelvic lymph node removal was 21.All surgical margins were negative.One patient received postoperative radiotherapy and chemotherapy because of 2 positive pelvic nodes.Another 7 patients received radiation therapy after the surgery because of complication of risk factors.Conclusion For the doctors with rich experience in laparoscopic gynecologic surgery and mastering the technique of single-port laparoscopic surgery,LESS-RH/ PLND is feasible and safe for cervical cancer patients.