腹腔镜子宫切除加盆腔淋巴结切除治疗子宫颈癌253例分析

目的探讨腹腔镜下广泛子宫切除术联合盆腔淋巴结切除术治疗早期宫颈癌的临床效果。方法 2006-07～2010-12对253例Ⅰa2～Ⅱb期的子宫颈癌,在全身麻醉下,腹腔镜下施行广泛性子宫切除联合盆腔淋巴结切除,并对其临床资料及随访情况进行回顾性分析。结果除5例中转开腹外(1例因腹腔镜手术器械的故障中转开腹,3例因髂血管损伤开腹修补,1例因缝针残留开腹寻找缝针断端),余248例均在腹腔镜下完成。手术时间155～276 min,平均210 min,术中出血量150～510 ml,平均321 ml。切除盆腔淋巴结10～21枚,平均15枚;术后肠道功能恢复时间2～3 d,平均2.5 d;术后留置尿管时间9～20 d,平均15.5 d。术中并发症18例:髂血管损伤7例,膀胱损伤3例,闭孔神经损伤3例,大网膜损伤2例,肠道损伤2例,缝针遗留腹腔1例。术后近期并发症30例:其中,阴道残端感染8例,麻痹性肠梗阻3例,尿道阴道瘘5例,膀胱阴道瘘4例,下肢深静脉栓塞6例,淋巴囊肿4例。术后远期并发症:膀胱功能障碍47例,直肠功能障碍48例。复发率7.5%,转移率7.0%;术后1年生存率为95.4%,术后3年生存率为85.8%。结论腹腔镜下广泛子宫切除联合盆腔淋巴结切除术治疗宫颈癌安全可行。

Clinical analysis on laparoscopic radical hysterectomy plus lymphadenectomy for 253 cases of cervical cancer

Objective To investigate the clinical effect of laparoscopic radical hysterectomy plus pelvic lymph node resection on cervical cancer.Methods From July 2006 to December 2010,a total of 253 laparoscopic radical hysterectomy plus lymphadenectomy procedures were performed onⅠa2-Ⅱb cervical carcinoma under general anesthesia.The clinical data and follow-up results were reviewed.Results The operation was completed under laparoscope in 248 cases,and 5 conversion to open surgery because of the failure of surgical instruments for laparoscope or iliac vein injury or the sew leaved behind in the abdomen.The operative time and blood loss were 155-276 min(mean,210 min) and 150-510 ml(mean,321 ml) respectively.Numbers of pelvic lymph nodes resected were 10-21(mean,15).The time to bowel function recovery and normal urine residual were 2-3 d(mean,2.5 d) and 9-20 d(mean,15.5 d) respectively.The operative complications included: 7 patients had vessel injuries,operative cystotomies occurred in 3 patients,3 patients had nerve injuries,2 patiens had epiploon injury,2 patiens had ascending colon injury,the sew leaved behind in the abdomen occurred in 1 patient.The postoperative complications included: 8 cases of vagina infections,3 cases of ileus,5 cases of uretero-vaginal fistula,4 cases of vesicovaginal fistula,6 cases of deep venous thrombosis,4 cases of lymphocyst.Long-term complications included: 47 cases of bladder dysfunction and 48 cases of rectum dysfunction.Recurrence rate was 7.5% and metastasis rate was 7.0%.The 1-year,3-year survival rate of the patients was 95.4% and 85.8%,respectively.Conclusion Laparoscopic radical hysterectomy plus pelvic lymph node dissection for cervical cancer is safe and feasible.