腹腔镜与开腹手术行广泛子宫切除加盆腔淋巴结清除术的临床效果比较

目的 比较腹腔镜与开腹手术行广泛子宫切除加盆腔淋巴结清除术的临床效果。方法 回顾性分析近2年我院经腹腔镜行广泛子宫切除加盆腔淋巴结清除术的26例子宫恶性肿瘤患者(腹腔镜组)的临床资料,随机抽取近4年行开腹同类手术的27例(开腹组)作为对照。结果腹腔镜组平均手术时间为310 min,开腹组为238 min;腹腔镜组平均切除的淋巴结22个,开腹组为16个;腹腔镜组术中平均出血量为756 ml,开腹组为1129 ml,腹腔镜组平均输血量为321 m1,开腹组为746 ml,腹腔镜组平均术后排气时间为37 h,开腹组为62 h;腹腔镜组术后体温恢复正常时间平均为5 d,开腹组为8 d;腹腔镜组平均应用抗生素时间为6 d,开腹组为8 d;以上各项数据两组间比较,差异均有极显著性(P<0.01)。两组在盆腔引流液(分别为321、216 ml)、尿管拔除时间(分别为13、10d)、术后第3天的白细胞计数(分别为11 × 109/L、10 × 109/L)、术后住院日(分别为26、26 d)及住院费用(分别为25 986、22 672元)等方面比较,差异均无显著性(P>0.05)。结论 腹腔镜下广泛子宫切除及盆腔淋巴结清除术可达到开腹手术的彻底性,并具有创伤小、恢复快等优点。     

Total laparoscopic radical hysterectomy and pelvic lymphadenectomy using harmonic shears

STUDY OBJECTIVE: To describe the feasibility and outcome of total laparoscopic radical hysterectomy with or without pelvic lymphadenectomy for patients with stage I cervical cancer or severe pelvic endometriosis using harmonic shears as the sole instrument for dissection, division, and maintenance of hemostasis of all major surgical pedicles. DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University hospital and affiliate institutions. PATIENTS: Seven patients who underwent total laparoscopic radical hysterectomy using harmonic shears for International Federation of Gynecology and Obstetrics stage IA2 to IB1 cervical cancer and pelvic endometriosis at our institution or affiliate hospital from January 2004 through February 2005. INTERVENTION: A retrospective review of patients that underwent total laparoscopic radical hysterectomy with or without pelvic lymphadenectomy at our institution using harmonic shears was performed. Information regarding preoperative, intraoperative, and postoperative events was recorded and analyzed. MEASUREMENTS AND MAIN RESULTS: Pelvic lymphadenectomy was performed in all cancer cases. Mean patient age was 40 years (range 30-53 years). Mean estimated blood loss was 143 mL (range 100-200 mL). Mean operating time was 293 minutes (range 255-385 minutes). Mean pelvic node count was 27.8 (range 24-34) for cancer cases. Mean hospital stay was 3.2 days (range 2-7 days). One patient developed a vaginal cuff abscess postoperatively that was managed conservatively with drainage in the office setting followed by intravenous antibiotics. Another patient developed urinary retention for 2 weeks after surgery. There were no other intraoperative or postoperative complications. CONCLUSION: Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using harmonic shears is a technically feasible and safe procedure. Larger studies and long-term follow-up are required to determine the oncologic outcomes of these patients.     

机器人辅助广泛性子宫切除术和盆腔淋巴结切除术的初步研究

目的 探讨将机器人手术系统应用于宫颈癌的广泛性子宫切除+盆腔淋巴结切除术的可行性.方法 2008年12月-2009年8月,采用da Vinci机器人手术系统,对5例Ⅰb1～Ⅱ a期宫颈癌患者行机器人辅助广泛性子宫切除+盆腔淋巴结切除术.记录手术时间、术中出血量、术中及术后并发症的发生情况、手术前后血红蛋白含量变化、术后体温及排气时间、术后恢复自主排尿时间、术后住院时间、病理检查结果、盆腔淋巴结切除数等.结果 5例患者全部顺利完成手术,无中转开腹,无术中或术后并发症出现.5例患者的手术时间分别为305、365、275、240和245 min,平均为286 min;术中出血量分别约为200、400、650、300和400 ml,平均为390 ml.5例患者术后最高体温均未超过37.5℃,术后36 h均排气.5例患者术后住院时间分别为11、13、9、12和12 d,平均为11.4 d.5例患者的病理检查结果均为鳞状细胞癌,阴道残端和宫旁切缘均无残留病灶.盆腔淋巴结切除数分别为14、22、16、21和18个,平均为18.2个,淋巴结无转移.结论 机器人手术系统可以应用于宫颈癌的广泛性子宫切除+盆腔淋巴结切除术,这一新方法为宫颈癌的手术治疗提供了一个新的选择.     

Radical vaginal hysterectomy with extraperitoneal pelvic lymphadenectomy in cervical cancer

OBJECTIVE: The aim of this work was to examine three types of radical vaginal hysterectomy with different degrees of radicality, performed in order to reduce surgical complications and sequelae in different indications, and to test the feasibility of a new simple and quick technique for extraperitoneal pelvic lymphadenectomy to be used in combination with radical vaginal hysterectomy for treatment of cervical cancer. In this way the advantages of vaginal surgery (e.g.: unnecessary general anaesthesia, reduced surgical trauma, applicability to obese and poor surgical risk patients, fast time-saving procedure) can be preserved. METHODS: We compared retrospectively the long-term results of radical vaginal and radical abdominal operations in a large series of stage IB-IIA cervical cancer patients treated at our institution in Florence from 1968 to 1983. Furthermore, we analysed the results of our experience from 1995 to 1998, when we performed extraperitoneal pelvic lymphadenectomy, followed by radical vaginal hysterectomy, on 48 patients affected by cervical cancer. Extraperitoneal pelvic lymphadenectomy was performed through two small abdominal incisions (6-7 cm). Twenty-two patients (45%) were obese (BMI>30 kg/m2) and 20 were poor surgical risks. FIGO stage was: IB1 in 18 cases, IB2 in eight, IIA in six, IIB in 12, IIIB in four. Neoadjuvant chemotherapy was given in 12 cases and preoperative irradiation was given in ten. General and regional anaesthesia were used in 30 (62.5%) and in 18 (37.5%) cases, respectively. RESULTS: As for past experience, in stage IB the five-year survival of 356 patients who underwent radical vaginal hysterectomy and that of 288 who had radical abdominal hysterectomy with pelvic lymphadenectomy were 81% and 75%, respectively (p<0.05). Surgical complications were fewer with no mortality in the first group. In stage IIA, survival rates were 68% for radical vaginal hysterectomy and 64% for radical abdominal hysterectomy, in 76 and 64 cases, respectively (p=n.s.). As for the more recent experience, median operative time for extraperitoneal pelvic lymphadenectomy was 20 minutes for each side (range 15-36). In each patient a median of 26 lymph nodes were removed (range 16-48). Positive nodes were found in 12 cases (25%). Median operative time for radical vaginal hysterectomy was 40 minutes (range 30-65). Extraperitoneal pelvic lymphadenectomy complications included: lymphocyst, five cases (10%) and retroperitoneal hematoma, one (2%); all occurred at the beginning of the experience. Radical vaginal hysterectomy complications included: ureteral stenosis, one (2%) and uretero-vaginal fistula, one (2%). All complications occurred in patients who received radiotherapy or chemotherapy preoperatively. Median hospital stay was ten days (range 6-20). CONCLUSIONS: The results of our work demonstrate that our technique for extraperitoneal pelvic lymphadenectomy shows a good applicability to cervical cancer patients submitted to radical vaginal hysterectomy, which has a high rate of cure for stage IB and IIA as shown by our past experience. The procedure of extraperitoneal pelvic lymphadenectomy was quick, easy, and safe, and its realization was not detrimental to the advantages of radical vaginal hysterectomy. Our experience supports the continued use of this combined extraperitoneal and vaginal approach in the treatment of cervical cancer. Moreover, the three classes of radical vaginal hysterectomy allow tailoring the type of the operation to the clinical and physical characteristics of the patients.     

Recurrent acute leg cellulitis after hysterectomy with pelvic lymphadenectomy

Summary. Recurrent acute leg cellulitis known to occur in patients with impaired venous or lymphatic circulation was surveyed prospectively in 270 patients after radical hysterectomy with pelvic lymphadenectomy and in 66 patients after hysterectomy with pelvic lymphadenectomy from 1977 to 1985. Among them, six (2%) and three (4%) patients experienced a total of 17 episodes of acute leg cellulitis, respectively. Analysis showed that postoperative percutaneous radiation therapy of the pelvic area was a highly significant risk factor. Penicillin prophylaxis is recommended for patients experiencing recurrent attacks.     

Recurrent acute leg cellulitis after hysterectomy with pelvic lymphadenectomy

Recurrent acute leg cellulitis known to occur in patients with impaired venous or lymphatic circulation was surveyed prospectively in 270 patients after radical hysterectomy with pelvic lymphadenectomy and in 66 patients after hysterectomy with pelvic lymphadenectomy from 1977 to 1985. Among them, six (2%) and three (4%) patients experienced a total of 17 episodes of acute leg cellulitis, respectively. Analysis showed that postoperative percutaneous radiation therapy of the pelvic area was a highly significant risk factor. Penicillin prophylaxis is recommended for patients experiencing recurrent attacks.     

Hysterectomy and pelvic organ dysfunction

Contrary to popular belief, there is now considerable evidence that simple abdominal hysterectomy does not adversely affect bladder, bowel and sexual function (collectively referred to as 'pelvic organ function'). This also appears to hold true for vaginal hysterectomy, although randomized studies are lacking. Furthermore, conservation of the cervix by performing a subtotal (supracervical) hysterectomy does not confer advantages over total hysterectomy as far as pelvic organ function is concerned. By contrast, as radical hysterectomy involves more extensive dissection of the pelvic organs and innervation, some degree of pelvic organ dysfunction might be expected. However, the small prospective studies available provide conflicting results, but major sexual problems after radical hysterectomy appear to be transient. Retrospective studies suggest that abdominal and particularly vaginal hysterectomy may predispose to vault prolapse. One study reported that subtotal hysterectomy may be associated with subsequent cervical prolapse. These issues can only be clarified when long-term follow-up of recently completed randomized trials are performed. Until then, myths regarding the most frequently performed major gynaecological operation need to be dispelled, and women requiring hysterectomy should be counselled using the best available evidence.     

Radical hysterectomy for treatment of cervical cancer: a prospective study of two methods of closed-suction drainage.

Two closed-suction drainage methods were prospectively compared in 96 patients after radical hysterectomy with pelvic lymphadenectomy in stage IB cervical cancer. In group 1 (n = 49) two pelvic sidewall drains and a vaginal drain were used, and in group 2 (n = 47) only the vaginal drain was used. The groups were similar for mean age, preoperative weight, hemoglobin and serum albumin level, operating time, operative blood loss, and blood transfusions. The febrile morbidity rates and the operative site infection rates were similar in the two groups. Ninety vaginal drains were removed by day 3. By day 6 55% of patients in group 1 had at least one sidewall drain, with a mean drainage of 150 ml/day. The median postoperative stay was similar in both groups. A pelvic lymphocyst developed in one patient in each group. The single vaginal closed-suction drain is safe, efficient, more acceptable to patients, and more cost-effective.     

Total laparoscopic radical hysterectomy (type II-III) with pelvic lymphadenectomy in early invasive cervical cancer

STUDY OBJECTIVE: To describe the feasibility and outcome of total laparoscopic radical hysterectomy with pelvic lymphadenectomy in early cervical cancer. DESIGN: Retrospective, nonrandomized study (Canadian Task Force classification II-2). SETTING: Acute-care, teaching hospital. PATIENTS: Twenty-seven nonconsecutive patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2 (n = 4) or IB1 (n = 23) cancer of the cervix. INTERVENTION: Laparoscopic type II (n = 9) or type III (n = 18) hysterectomy with systematic bilateral pelvic lymphadenectomy. Monopolar coagulation, vascular clips, and harmonic scalpel were used. Resection of the cardinal and uterosacral ligaments was performed with Endo GIA stapling and the harmonic scalpel. MEASUREMENTS AND MAIN RESULTS: Histopathologically, there were 20 cases of squamous carcinoma, 6 adenocarcinomas, and 1 adenosquamous carcinoma. The operation was performed entirely by laparoscopy in 26 patients. One patient underwent laparotomy because of equipment failure. The patients' mean age was 45.1 years (95% CI 41.7-48.4), with a median body mass index of 26.0 kg/m2. The mean number of resected pelvic nodes was 19.1 (95% CI 17.02-21.2). Three patients had microscopic metastatic nodal disease. The surgical margins were free of disease in all cases. The median blood loss was 400 mL (range 250-700 mL). The median length of stay was 5 days. Major intraoperative complications did not occur. All patients are free of disease after a median follow-up of 32 months (range 4-52 months). CONCLUSION: Radical hysterectomy can be successfully completed by laparoscopy in patients with early cervical cancer. This procedure may reduce the morbidity associated with abdominal or transvaginal radical hysterectomy.     

Vertical rectus abdominis myocutaneous flap for vaginal reconstruction after radical pelvic surgery for Stage II vaginal carcinoma

Primary carcinomas of the vagina are uncommon, occurring only 2-3% of all gynecological malignancies. In women with early stage of disease, primary surgery, consisting of radical vaginectomy (plus hysterectomy in patients with tumors involving the upper vagina) and systematic dissection of lymphatic drainage of tumor, is a valid option. In these patients, a rectus abdominis myocutaneous (RAM) flap may be favorably used for vaginal reconstruction during radical pelvic surgery. Here we describe a case of Stage II vaginal carcinoma treated with radical pelvic surgery and vertical-RAM (V-RAM) flap reconstruction.     

Selective pelvic and periaortic lymphadenectomy does not increase morbidity in surgical staging of endometrial carcinoma.

OBJECTIVE: The objective of this study was to retrospectively assess whether there was increased morbidity associated with the addition of selective pelvic and periaortic lymphadenectomy to hysterectomy in patients with endometrial carcinoma. STUDY DESIGN: From 1977 through 1988, 196 patients undergoing selective pelvic and periaortic lymphadenectomy plus hysterectomy were compared with 104 patients who underwent hysterectomy alone for endometrial adenocarcinoma. RESULTS: Only after adjusting for covariates was selective pelvic and periaortic lymphadenectomy associated with a higher estimated blood loss, which increased linearly with weight and was higher for black than for white women. The transfusion rate was similar for the two groups (selective pelvic and periaortic lymphadenectomy 6%, hysterectomy 10%). The mean blood loss was significantly different among the four gynecologic oncology surgeons (range 343 to 652 ml). The operating time primarily depended on patient weight and race, surgeon, and estimated blood loss. Postoperative hospital stay increased significantly with age, surgeon, wound infections, thrombotic events, and serious complications. Selective pelvic and periaortic lymphadenectomy had no effect on wound infections, which were directly related to operating time. Seventy-five (38%) of the selective pelvic and periaortic lymphadenectomy group and 19 (18%) of the hysterectomy group (p < 0.01) received whole-pelvic radiation with no difference in bowel complications (selective pelvic and periaortic lymphadenectomy 2/75, hysterectomy 1/19). The risk of serious complications was associated only with increasing age. CONCLUSION: Selective pelvic and periaortic lymphadenectomy in patients with endometrial carcinoma does not significantly add to morbidity from hysterectomy, which is related primarily to other factors such as patient weight, age, and race; operating time; and surgeon.     

Maylard incision for radical hysterectomy and pelvic and para-aortic lymph node dissection

Angioli R, Koechli OR, Sevin B-U. Maylard incision for radical hysterectomy and pelvic and para-aortic lymph node dissection. Int J Gynecol Cancer 1998; 8 : 274–278.
Although the transverse, muscle-splitting technique for abdominal incision (Maylard incision) has been described for radical hysterectomy and for lymph node dissection of the pelvis and para-aortic area, the adequacy of the procedure performed through this incision has not been assessed. From 1991 to 1994, 205 patients underwent radical hysterectomy with pelvic lymph node (PLN) and para-aortic lymph node (PALN) dissection at the Division of Gynecologic Oncology, Jackson Memorial Hospital/University of Miami School of Medicine. Twenty-four patients with cervical cancer stage IB-IIA underwent radical hysterectomy, pelvic lymph node and para-aortic lymph node dissection through a Maylard incision. Three patients had panniculectomy performed at the same time. Duration of surgery, estimated blood loss, number of pelvic and para-aortic lymph nodes removed and duration of hospital stay were within acceptable ranges. Postoperative and intraoperative complications were minimal. Excellent cosmetic results were obtained. In conclusion, the Maylard incision offers good exposure to the pelvic and para-aortic area for lymph node dissection, good cosmetic result, and can be performed in association with abdominoplasty. Complications are similar to those observed with a vertical skin incision. This type of incision should be considered in selected young patients with early cervical cancer and in obese patients desiring abdominoplasty.     

Long-term effects on bladder function following radical hysterectomy with and without postoperative radiation

Sixty-one patients with Stage IB cervical carcinoma treated initially by Type III radical hysterectomy underwent water cystometry 6 or more months after surgery. Adjunctive pelvic radiation in 10 patients was associated with significantly more contracted (P less than 0.001) and unstable (P less than 0.01) bladders than surgery alone. The necessity for bladder drainage 30 or more days after surgery alone in 17 patients was associated with significantly worse (P less than 0.05) long-term post-void residual and total bladder capacity as well as volume for first urge to void compared to 34 patients treated only with surgery who required short-term drainage. Management of bladder drainage following radical hysterectomy is discussed.     

Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy

OBJECTIVE: The purpose of this study was to incorporate a wide range of operative laparoscopic techniques to complete a type III radical hysterectomy with aortic and pelvic lymphadenectomy. STUDY DESIGN: A type III radical hysterectomy with bilateral aortic and pelvic lymph node dissection was separated into eight component parts: (1) right and left aortic lymphadenectomy, (2) right and left pelvic lymphadenectomy, (3) development of the paravesical and pararectal spaces, (4) ureteral dissection, (5) ligation and dissection of the uterine artery, (6) development of the vesicouterine and rectovaginal spaces, (7) resection of the parametria, and (8) resection of the upper vagina. The adequacy of the component parts was determined and documented on video. RESULTS: Complete aortic and pelvic lymphadenectomy and a type III radical hysterectomy were performed by operative laparoscopy. Argon beam coagulation and countertraction facilitated pelvic and aortic lymph node dissection, including removal of nodal tissue lateral to the iliac vessels. Ureteral dissection with resection of the cervicovesical fascia (”the tunnel”) was completed with right-angle dissectors, vascular clips, and argon-beam coagulation. Resection of the cardinal and ureterosacral ligaments was successful by use of Endo-GIA stapling instruments (United States Surgical Corporation, Norwalk, Ct.). CONCLUSION: A complete pelvic and aortic lymphadenectomy and type III radical hysterectomy were performed laparoscopically. This approach could potentially decrease morbidity historically associated with radical hysterectomy and lymphadenectomy performed either abdominally or vaginally. Only prospective randomized trials will allow for the evaluation of potential benefits associated with this surgical technique. (Am J Obstet Gynecol 1996;174:1763-8.)     

Factors affecting operative blood loss from open radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer

Purpose

To evaluate the effect of clinical and tumor factors on operative blood loss during open radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer.

Methods

Clinical, pathological, and operative data of 456 women with cervical cancer stage IA2–IIA who had open radical hysterectomy with bilateral pelvic lymphadenectomy (RHPL) from January 2003 to December 2005 were reviewed with regard to operative blood loss of 600?ml or more.

Results

Parity (RR 1.67; 95?% CI 1.02–2.73; p value 0.04) and salpingo-oophorectomy (RR 1.57; 95?% CI 1.06–2.31; p value 0.02) were statistically associated with operative blood loss of 600?ml or more from multivariate analysis. Preoperative chemotherapy (RR 1.87; 95?% CI 1.18–2.96; p value?2 (RR 1.73; 95?% CI 1.08-2.75; p value 0.02) were significantly associated with blood loss of more than 1,000?ml in the multivariate analysis.

Conclusion

High parity (3 or more) and incidental salpingo-oophorectomy are related to an increased risk of operative blood loss of 600?ml or more during open RHPL. However, the effects were marginal and no clear explanation for the underlying mechanisms is available. Preoperative chemotherapy and overweight were independent predictors of operative blood loss of more than 1,000?ml.     

Laparoscopic-assisted radical parametrectomy including pelvic and/or paraaortic lymphadenectomy in women after prior hysterectomy-three cases

BACKGROUND: Radical abdominal surgery in patients who have previously undergone a hysterectomy is a surgical challenge. This type of surgery for invasive cervical cancer after a hysterectomy or vaginal stump metastasis traditionally requires a major laparotomy; however, a minimal-access approach is now being applied to this type of procedure. CASE: A laparoscopic-assisted radical parametrectomy including a pelvic and/or paraaortic lymphadenectomy was performed on two patients presenting invasive cervical cancer diagnosed after a simple hysterectomy and one patient with recurred endometrial cancer in the vaginal stump. All three patients had an excellent clinical outcome and made a rapid recovery with no major complications, even though two cases involved a bladder laceration. CONCLUSION: A laparoscopic radical parametrectomy including a pelvic and/or paraaortic lymphadenectomy is a viable technique for women with invasive cervical cancer or recurrent endometrial vaginal cancer after a prior hysterectomy.     

Study on the possibility of bacterial infection through pelvic suction drainage via the vagina set after radical hysterectomy

This study was aimed at clarifying the possibility of bacterial infection through pelvic drainage via the vagina set in the bilateral dead spaces created by radical hysterectomy with lymphnode dissection. Thirty seven patients with uterine cancer underwent radical hysterectomy with lymphnode dissection. Four patients with uterine cancer underwent modified-radical hysterectomy with lymphnode dissection. Silicon suction drains were set in the bilateral dead spaces via the vagina for 3 days. Exudate from the vaginal vault and exudate from each dead space collected aseptically and cultured under aerobic or anaerobic conditions, and the bacterial species were isolated and identified. Bacterial species were found in 75.6% of the vaginal vaults, 42.5% of the right dead spaces and 33.3% of the left dead spaces. When these bacterial species were isolated and identified from dead spaces, it was discovered that the same bacterial species were found in 76.5% of the right dead spaces as in the vaginal vaults and 90.9% in case of the left dead spaces. These results suggest that the pelvic suction catheter introduced via the vagina acts as a vehicle of bacterial infection.     

Central pelvic recurrence 7 years after radical vaginal trachelectomy

BACKGROUND: We report a case of central pelvic recurrence 7 years after radical vaginal trachelectomy for adenocarcinoma of the cervix. CASE: A 30-year-old woman was treated by radical vaginal trachelectomy and bilateral pelvic lymph node dissection (a fertility sparing procedure) in 1996 for cervical cancer. Pathology demonstrated a well differentiated, stage 1B1 adenocarcinoma. She presented 7 years later with a central pelvic recurrence measuring 30 mm in width. She subsequently underwent radical hysterectomy for central clearance and did not require post-operative radiotherapy. CONCLUSIONS: Should selected patients who were initially treated by radical trachelectomy for early stage cervical cancer, in particular those with adenocarcinoma (as 50% of recurrences have been reported in this group of patients), be offered hysterectomy once child bearing is complete?     

阴式广泛全子宫切除加腹腔镜下淋巴结切除术与开腹手术治疗早期宫颈癌疗效比较

目的探讨阴式广泛全子宫切除加腹腔镜下淋巴结切除术治疗早期宫颈癌的临床价值。方法 2004年11月至2011年4月于佛山市妇幼保健院,回顾性分析行阴式广泛全子宫切除加腹腔镜下淋巴结切除术的90例早期宫颈癌患者(阴式组)的病例资料,抽取同期行开腹广泛全子宫切除加盆腔淋巴结切除术42例(开腹组)作为对照。结果两组手术时间差异无统计学意义(P>0.05)。阴式组术中出血量[(348±114)mL]、肠道功能恢复时间[(36.76±4.9)h]、住院天数[(10.56±2.10)d]均少于开腹组的[(398±127)mL]、[(40.09±6.5)h]、[(11.79±2.45)d],差异有统计学意义(P<0.05)。阴式组切除阴道长度[(3.12±0.17)cm]大于开腹组的[(3.05±0.21)cm](P<0.05)。阴式组尿潴留发生率(30.0%)较开腹组(11.9%)高(P<0.05)。阴式组术后5年内复发率(14.6%)低于开腹组(31.5%)(P<0.05)。结论阴式广泛全子宫切除加腹腔镜下淋巴结切除术式创伤小,术后恢复快,手术彻底,有临床应用价值。     

Feasibility and morbidity of total laparoscopic radical hysterectomy with or without pelvic limphadenectomy in obese women with stage I endometrial cancer

Objective  The aim of this study was to describe the feasibility and morbidity rates associated with total laparoscopic radical hysterectomy (TLRH) with or without pelvic lymphadenectomy for stage I endometrial cancer in obese women. Patients and methods  Obese patients with stage I endometrial cancer who underwent total laparoscopic radical surgery at the Department of Obstetrics and Gynecology of San Gerardo Hospital were compared to nonobese patients. The same group of obese patients was compared with patients who underwent radical laparotomic surgery. Obesity was defined as a body mass index more than 30 kg/m². Results  Between September 2003 and September 2007, 75 women underwent TLRH. Median age was 54 years and median body mass index was 28 kg/m². Thirty-seven women were obese. There were no differences between nonobese and obese women in operative, time length of parametria and pelvic nodes removed and operative or late complications. Blood loss was significantly higher in obese patients. Comparing retrospectively laparoscopy and laparotomy in obese women treated in our center, laparotomy was associated with decreased operative time, but also with increased blood loss, transfusion rate, duration of hospitalization and frequency of post surgical complications. Conclusions  Total laparoscopic radical hysterectomy (with pelvic lymphadenectomy) is a safe option in patients with endometrial cancer. Obesity is not a contraindication to perform a TRLH with no differences in surgical parameters between obese and nonobese population. TLRH show a significant decrease of complications compared to laparotomic radical surgery in obese women.