早期子宫颈癌腹腔镜与开腹下广泛性子宫切除术及淋巴清扫术的疗效研究

目的探讨腹腔镜及开腹下广泛性子宫切除术及淋巴结清扫术对早期子宫颈癌的疗效。方法回顾性分析83例确诊为早期宫颈癌并分别行腹腔镜及开腹下广泛性子宫切除及淋巴清扫术患者的临床资料,37例采用腹腔镜下手术为腹腔镜组,46例采用开腹手术为开腹组。比较2组患者的手术时间、术中出血量、宫旁及阴道切除长度、淋巴结切除数目、肛门排气时间、尿管拔除时间、住院时间、并发症发生率等指标。结果相比开腹组,腹腔镜组手术时间长、术中出血量少、术后肛门排气时间快及住院时间短,差异均有统计学意义（P值分别为0.000、0.003、0.000、0.037,P均〈0.05）;而淋巴结切除数、切除范围（宫旁、阴道）、盆腔引流量、术后尿管拔除时间这几个指标的比较,差异均无统计学意义（P值分别为0.178、0.105、0.097、0.551、0.74,P均〉0.05）。较开腹组,腹腔镜组术后尿潴留发生率明显低于开腹组,分别为37.0%和16.2%,差异有统计学意义（P=0.036〈0.05）。而脏器损伤、大出血、淋巴囊肿无统计学意义（P值分别为0.582、0.453、0.332,P均〉0.05）。结论腹腔镜下广泛性子宫切除及淋巴清扫术可以达到与开腹手术治疗早期宫颈癌的疗效,并具备了术中出血量少、术后恢复快、并发症少的优点。因此,腹腔镜下广泛性子宫切除及淋巴清扫术是一种理想术式。

Comparative study between laparoscopic and open radical hysterectomy combined with pelvic lymphadenectomy in the treatment of early cervical cancer

To investigate the effects of the laparoscopic radical hysterectomy combined with pelvic lym- phadenectomy and conventional abdominal radical hysterectomy in the treatment of early cervical cancer. Methods Total 83 early cervical cancer patients＇ clinical data in our hospital were selected and studied. 37 cases who employed laparoscopic surgery were called the laparoscopic group and 46 cases who employed laparotomy group were called the surgery group. Compar- ing the indicators of two groups patients such as operative time,blood loss,resection length of uterine and vaginal wall,number of lymph node dissection,recovery time of intestines function,recovery time of urinary system,hospitalization time,complication rate. Results Compared with the surgery group,the laparoscopic group needed more time,less blood loss,less recovery time of intestines function and shorter hospital stay,the differences were statistically significant（P values was 0.000,0.003,0.000,0.037, 0.05 respectively）; While the number of lymph node,resection range of uterine and vaginal,amount of pelvic drainage,recovery time of urinary system,the differences were not statistically significant（P values was 0.178,0.105,0.097,0.551,0.74,0.05 re- spectively）. Compared with laparotomy group,the incidence of postoperative urinary retention of the laparoscopic group was sig- nificantly lower than the laparoscopic group, it was 37.0% vs16.2%,the difference was statistically significant（P value 0.036 0.05）. The injury of organ,bleeding,lymphocele were not statistically significant between two groups（P values was 0.582,0.453, 0.332, 0.05 respectively）. Conclusion Laparoscopic radical hysterectomy and lymph node dissection whose advantages contained less blood loss,rapid postoperative recovery,less complication, has the similar effects compared with conventional abdominal radical hysterectomy. Therefore,laparoscopic radical hysterectomy and lymph node dissection should be an ideal surgical procedure.