阴式广泛全子宫切除加腹腔镜盆腔淋巴结清扫术治疗早期宫颈癌效果观察

目的探讨阴式广泛全子宫切除加腹腔镜盆腔淋巴结清扫术治疗早期宫颈癌的效果。方法随机将2012-08—2016-01间接受广泛全子宫切除加腹腔镜盆腔淋巴结清扫术的54例早期宫颈癌患者分为2组,各27例。观察组实施阴式联合腹腔镜手术,对照组采用开腹手术。比较2组的手术时间、术中出血量、淋巴清扫数目、术后肛门排气时间及住院时间。结果 2组均成功完成手术,术后恢复良好。2组手术时间、淋巴结清扫数目比较,差异无统计学意义(P0.05)。观察组术中出血量、术后肛门排气时间及住院时间均优于对照组,差异有统计学意义(P0.05)。术后随访1a,2组患者均未出现复发病例。结论对早期宫颈癌患者实施阴式广泛全子宫切除加腹腔镜盆腔淋巴结清扫术,创伤小、术后并发症发生率低,患者恢复快,安全有效。     

腹腔镜下广泛子宫切除、盆腔淋巴结清扫术治疗子宫恶性肿瘤

目的探讨腹腔镜广泛子宫切除、盆腔淋巴结清扫术治疗子宫恶性肿瘤的可行性及临床效果。方法比较2007年3月～2008年3月11例腹腔镜手术与同期26例开腹手术行广泛子宫切除、盆腔淋巴结清扫治疗的子宫内膜癌、子宫颈癌的临床资料,观察2组手术时间、术中出血量、淋巴结切除数量、术后病率、肠道排气时间、住院日等。结果腹腔镜组子宫内膜腺癌3例（ⅠB期2例,ⅡA期1例）,子宫颈鳞癌8例（ⅠA期1例,ⅠB期5例,ⅡA期2例）;开腹组子宫内膜腺癌7例（ⅠB期5例,ⅡA期2例）,子宫颈鳞癌19例（ⅠA期2例,ⅠB期14例,ⅡA期3例）。2组差异无显著性（P〉0．05）。与开腹组相比,腹腔镜组术中出血量少[（216．8±125．4）ml vs（402．1±135．2）ml,t=-3．889,P=0．000],切除淋巴结多[（19．9±6．5）个vs（14．6±5．6）个,t=2．510,P=0．017],术后排气早[（34．6±6．5）h vs（56．4±7．6）h,t=-8．300,P=0．000],住院时间短[（14．6±3．5）d vs（19．4±5．6）d,t=-2．622,P=0．013];2组手术时间、术后病率、尿潴留的发生率差异无显著性（P〉0．05）。2组分别随访（11．0±3．2）和（12．0±2．8）月,无复发证据。结论腹腔镜下治疗子宫恶性肿瘤创伤小,恢复快,是一种安全有效的手术方法。     

腹腔镜广泛子宫切除及盆腔淋巴结清扫术的临床体会

目的:总结腹腔镜广泛子宫切除及盆腔淋巴结清扫术的手术经验及并发症的预防。方法:回顾分析2010年3月至2011年6月为32例患者施行腹腔镜广泛子宫切除及盆腔淋巴结清扫术的临床资料。结果:32例患者中,1例术后9 d发生膀胱阴道瘘(迟发性电损伤所致);1例术毕查看尿袋,见气体充盈张力较大,证实膀胱损伤;余30例手术效果满意。结论:腹腔镜广泛子宫切除及盆腔淋巴结清扫术出血少,并发症少,术后康复快,安全可行,充分体现了妇科领域微创手术的优势。     

腹腔镜下广泛全子宫切除联合盆腔淋巴结清扫术治疗子宫恶性肿瘤28例临床分析

目的 探讨腹腔镜广泛子宫切除联合盆腔淋巴结清扫术治疗子宫恶性肿瘤的临床价值.方法 气管插管静脉复合麻醉,膀胱截石位.放置举宫器,建立气腹,脐孔及左右两侧腹壁穿刺置入trocar.先行双侧盆腔淋巴结清扫,自上而下清扫髂总、髂外、腹股沟深3组淋巴结,进而清扫闭孔及髂内2组淋巴结.子宫动脉自髂内动脉起始处游离凝断,游离输尿管,分离双侧膀胱侧窝、直肠侧窝,游离主韧带、骶韧带3.0 cm以上切除,下推膀胱、直肠,游离阴道壁3.0 cm以上,并于3.0 cm处切除子宫标本,标本经阴道取出.结果 28例全部手术成功,无中转开腹.18例宫颈癌手术时间（213.3±38.6） min,术中出血量（223.3±89.6） ml,膀胱功能恢复时间（16.5±4.3）d,切除淋巴结（14.3±6.8）枚,术后并发症发生率16.7%（3/18）,术后发热时间（4.3±2.6）d,术后肛门排气时间（20.4±3.8）h;术后3例（16.7%,3/18）补充放疗、化疗.10例子宫内膜癌手术时间（221.3±37.7） min,术中出血量（231.9±71.4）ml,膀胱功能恢复时间（14.2±9.1）d,切除淋巴结（15.9±7.3）枚,术后1例发生并发症,术后发热时间（4.6±3.4）d,术后肛门排气时间（19.2±8.9）h;术后2例补充放疗、化疗.所有病例断端及阴道切缘均阴性.28例术后随访3~23个月,平均20个月,无复发,无一例发生穿刺部位肿瘤种植.结论 腹腔镜广泛子宫切除联合盆腔淋巴结清扫术治疗子宫颈癌和子宫内膜癌,手术视野清晰,手术安全,效果理想.     

腹腔镜下广泛子宫切除加淋巴结清扫术治疗子宫恶性肿瘤42例分析

目的探讨腹腔镜广泛子宫切除加淋巴结清扫术治疗子宫恶性肿瘤的可行性及临床效果。方法回顾分析2007年3月～2011年12月42例腹腔镜手术与同期46例开腹手术行子宫广泛切除、淋巴结清扫治疗的子宫恶性肿瘤的临床资料,比较2组的术中、术后情况。结果与开腹组相比,腹腔镜组术中出血量少[(303.4±118.2)ml vs.(407.6±120.2)ml,t=-4.094,P=0.000],切除淋巴结多[(27.5±5.1)个vs.(20.6±4.3)个,t=6.881,P=0.000],术后排气早[(1.5±0.5)d vs.(2.1±0.6)d,t=-5.069,P=0.000];2组手术病理分期、手术时间、术后并发症的发生率差异无显著性。结论腹腔镜下治疗子宫恶性肿瘤创伤小,恢复快,是一种安全有效的手术方法。     

腹腔镜下广泛性子宫切除加盆腔淋巴结清扫术的手术配合

对81例子宫癌患者行腹腔镜下广泛性子宫切除及盆腔淋巴结清扫术。结果均顺利完成手术，手术时间2．5～3．0h，术中出血100～200ml；无并发症发生，术后恢复良好，切口一期愈合。提出认真做好术前准备和术前访视，熟练掌握手术步骤，术中与医生密切配合是保证手术顺利完成的关键。     

腹腔镜根治性宫颈切除术联合盆腔淋巴结清扫术治疗早期宫颈癌6例报告

目的 探讨腹腔镜根治性宫颈切除术联合盆腔淋巴结清扫术治疗早期宫颈癌的可行性。方法 2003年4月～2005年4月，我院对要求保留子宫的6例早期宫颈癌先行腹腔镜下盆腔淋巴结清扫术，若冰冻病理回报阴性，在不离断子宫血管及圆韧带的情况下，游离输尿管，切断主韧带2cm，然后经阴道横断子宫颈及2cm阴道。结果 手术时间75～150min，平均120min。术中出血量100～250ml，平均150ml。6例均无并发症，术后1个月恢复正常月经。6例随访5～24个月，平均14．6月，均未发现复发，1例怀孕13周。结论 早期宫颈癌行腹腔镜根治性宫颈切除联合盆腔淋巴结清扫术可行，可以保留患者的生殖功能。     

腹腔镜辅助阴式与开腹广泛子宫切除术治疗早期宫颈癌的比较

目的 探讨腹腔镜辅助阴式广泛子宫切除联合盆腔淋巴结清扫术治疗早期宫颈癌的临床效果.方法 回顾性分析我院2005年6月～2011年12月146例临床资料完整的Ⅰ a2～Ⅱb期宫颈癌,83例腹腔镜辅助阴式广泛子宫切除联合盆腔淋巴结清扫术设为研究组,63例开腹广泛子宫切除联合盆腔淋巴结清扫术设为对照组,比较2组手术时间、术中出血量、切除淋巴结数量、术后镇痛药应用、术后排气时间、体温恢复正常时间、拔除盆腔引流管时间、手术并发症、术后生存情况等.结果 与对照组比较,研究组术中出血少[(283.3±162.3) ml vs.(372.9±194.5) ml,t=-3.032,P=0.003]、术后应用镇痛药例数少[15例vs.57例,x2=75.116,P=0.000]、术后排气早[(39.1 ±17.5)h vs.(48.3±19.4)h,t=-3.002,P=0.003]、体温恢复正常快[(47.5±19.7)h vs.(56.1±23.2)h,t=-2.419,P=0.017]、拔除盆腔引流管早[(3.6±1.6)d vs.(4.4±2.7)d,t=-2.090,P=0.039].2组在手术时间[(227.3 ±62.5)min vs.(235.1±67.7)min,t=-0.721,P=0.472]、切除淋巴结数[(22.6±5.7)枚vs.(20.7±6.4)枚,t=1.892,P=0.061]、并发症发生率[41.0％ (34/83) vs.57.1％ (36/63),x2=3.756,P=0.053]及术后复发率[13.2％(11/83) vs.14.3％(9/63),x2=0.032,P=0.857]比较无统计学差异.截止2012年5月30日,研究组83例术后平均随访63.4月(5～77个月),对照组63例术后平均随访62.3月(9～ 79个月),2组术后生存率比较无统计学差异(x2=0.026,P=0.872).结论 腹腔镜辅助阴式广泛子宫切除术创伤小,术后恢复快,近、远期疗效好,是治疗早期宫颈癌安全有效的手术方法.     

腹腔镜下广泛子宫切除加盆腔淋巴结清扫术与开腹手术的比较

目的通过比较腹腔镜与开腹广泛子宫切除及盆腔淋巴结清扫,探讨腹腔镜技术在妇科宫颈癌根治术中的可行性及应用价值。方法将2010年6月至2012年10月,于本院就诊的128例宫颈癌患者．在自愿原则下分为腹腔镜组和开腹组,探讨手术获取阴道长度及宫旁长度、淋巴结数、手术时间、术中出血量、肛门排气时间、留置尿管时间、盆腔引流液量、体温恢复正常时间、术后住院时间、术中及术后并发症、术后随访等方面的数据差异。结果腹腔镜组与开腹组在数据差异上具有统计学意义（P〈0．05）。结论腹腔镜广泛子宫切除及盆腔淋巴结清扫术在治疗早期宫颈癌的疗效上,与开腹手术相当,可作为早期子宫颈癌手术治疗的选择术式之一,值得推广。     

腹腔镜下广泛子宫切除加盆腔淋巴结清扫术(附30例报告)

目的:评价腹腔镜下广泛子宫切除加盆腔淋巴结清扫术治疗子宫颈癌和子宫内膜癌的实用价值,总结其优点及手术注意事项。方法:对12例子宫内膜癌、18例子宫颈癌施行腹腔镜下广泛子宫切除加盆腔淋巴结清扫术。结果:除1例中转开腹外,其余患者均在腹腔镜下完成手术,切除淋巴结19.5个(13~24个)。术中重要脏器损伤2例,发生率为6.67%。术后并发症发生率13.33%。子宫内膜癌术后复发率8.33%。子宫颈癌术后复发率5.56%。结论:腹腔镜下广泛子宫切除加盆腔淋巴结清扫术具有创伤小、术野清晰、并发症少、术后康复快等优点,并具有开腹手术的效果。     

Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer

BACKGROUND AND OBJECTIVES: To compare intraoperative, pathologic and postoperative outcomes of robotic radical hysterectomy (RRH) to total laparoscopic radical hysterectomy (TLRH) in patients with early stage cervical carcinoma. METHODS: We prospectively analyzed cases of TLRH or RRH with pelvic lymphadenectomy performed for treatment of early cervical cancer between 2000 and 2008. RESULTS: Thirty patients underwent TLRH and pelvic lymphadenectomy for cervical cancer from August 2000 to June 2006. Thirteen patients underwent RRH and pelvic lymphadenectomy for cervical cancer from April 2006 to January 2008. There were no differences between groups for age, tumor histology, stage, lymphovascular space involvement or nodal status. No statistical differences were observed regarding operative time (323 vs 318 min), estimated blood loss (157 vs 200 mL), or hospital stay (2.7 vs 3.8 days). Mean pelvic lymph node count was similar in the two groups (25 vs 31). None of the robotic or laparoscopic procedures required conversion to laparotomy. The differences in major operative and postoperative complications between the two groups were not significant. All patients in both groups are alive and free of disease at the time of last follow up. CONCLUSION: Based on our experience, robotic radical hysterectomy appears to be equivalent to total laparoscopic radical hysterectomy with respect to operative time, blood loss, hospital stay, and oncological outcome. We feel the intuitive nature of the robotic approach, magnification, dexterity, and flexibility combined with significant reduction in surgeon's fatigue offered by the robotic system will allow more surgeons to use a minimally invasive approach to radical hysterectomy.     

腹腔镜保留盆腔神经的广泛子宫切除治疗子宫肿瘤

目的回顾性分析腹腔镜下保留盆腔自主神经的广泛子宫切除术在子宫肿瘤患者治疗中的可行性。 方法选择2013年8月至2015年6月在新乡市中心医院接受手术治疗的早期宫颈癌及Ⅱ期子宫内膜癌患者95例,其中43例患者接受腹腔镜保留盆腔神经的广泛子宫切除术 ＋ 盆腔淋巴结清扫术(A组),52例患者行经腹广泛子宫切除 ＋ 盆腔淋巴结清扫术(B组)。总结两组的手术时间、术中出血量、切除宫旁组织及阴道长度、淋巴结数量,以及术后膀胱、直肠及性功能恢复情况。 结果两组的手术时间、切除范围及淋巴结数量差异无统计学意义(P> 0.05);两组的术中出血量,以及术后膀胱、直肠及性功能评估治疗比较[(180±55)ml vs (340±75)ml, (51.2±10.3)h vs (74.9±12.8) h, (11.6±2.1) d vs (18.3±2.9) d, 19.9分 vs 23.4分],差异有统计学意义(P<0.05)。 结论腹腔镜下保留盆腔神经的广泛子宫切除术在子宫肿瘤中是安全可行的,与传统术式相比更有利于膀胱直肠功能恢复,提高生命质量。     

腹腔镜广泛子宫切除术641例并发症分析

目的:探讨腹腔镜广泛子宫切除术后并发症的发生原因及处理方法.方法:回顾性分析2006年1月-2011年1月在解放军总医院妇产科临床诊断为宫颈癌和子宫内膜癌并行腹腔镜广泛子宫切除术的641例患者手术并发症的发生和处理情况,并与963例行开腹广泛子宫切除术的宫颈癌和子宫内膜癌患者的术后并发症发生情况进行比较.结果:行腹腔镜...     

腹腔镜根治性膀胱切除术中盆腔淋巴结清扫的技术改进

目的介绍腹腔镜根治性膀胱切除术中盆腔淋巴结清扫的手术方法改进及其疗效。方法2002年12月至2007年12月我院施行了129例膀胱癌腹腔镜盆腔淋巴结清扫术。本组男性111例,女性18例。手术技巧的改良分为早期探索阶段和技术标准化阶段。早期探索阶段（25例）：尝试不同器械、不同手术次序、不同手术技巧的淋巴结清扫方法;技术标准化阶段（104例）：采用吸引器、电凝钩及血管闭合器（LigaSure）相结合的方法,按标准化的手术次序进行盆腔淋巴结清扫,其中13例施行扩大淋巴结清扫。结果全部病例盆腔淋巴结清扫术在腹腔镜下顺利完成。技术标准化阶段完成双侧标准盆腔淋巴结清扫术（91例）时间（76．1±17．8）min,出血量（62．6±30．7）ml,术中损伤髂外静脉（1．1％,1／91）,术后淋巴漏发生率（2．2％,2／91）,与早期探索阶段相比较,手术时间缩短、出血量减少、并发症减少。术后随诊1～5年,无继发出血,无下肢淋巴水肿,8例出现局部复发,6例发生远处转移。结论采用吸引器、电凝钩及LigaSure相结合的改良方法行腹腔镜盆腔淋巴结清扫术能减少术中并发症,缩短手术时间,减少术后淋巴漏,肿瘤控制效果满意。     

Surgical and oncologic outcomes between laparoscopic and radical abdominal hysterectomy for IB1-IIA2 cervical cancer

ObjectiveTo compare sugrical and survival outcomes between laparoscopic radical hysterectomy (LRH) and radical abdominal hysterectomy (RAH).MethodsAll the patients with IB1-IIA2 cervical cancer who performed LRH or RAH in Fudan University Shanghai Cancer Center between 1/2016 and 12/2017 were retrospectively analyzed.ResultsThere were no significant differences between LRH and RAH groups except deep stromal invasion (35.2% vs 54.4%, p = 0.000), operating time (232.3 ± 61.9 min vs. 106.7 ± 36.2 min, p = 0.000), blood loss (169.5 ± 96.2 ml vs. 219.6 ± 149.3 ml, p = 0.000), and lymph node counts (21.1 ± 7.1 vs. 23.2 ± 8.7 min, p = 0.012). The LRH group displayed poorer disease-free survival (DFS) (5-year rate, 79.4% vs. 90.0%; p = 0.046) and overall survival (OS) (5-year rate, 74.7% vs. 90.0%; p = 0.026) compared to the RAH group. On multivariate analysis, LRH was an independent risk factor for DFS (hazard ratio, 0.377; 95% confidence interval [CI], 0.227–0.625; p = 0.000) and OS (hazard ratio, 0.434; 95% CI, 0.254–0.740; p = 0.003).ConclusionsLRH affected the survival of cervical cancer patients with tumor size >2 cm (p < 0.05). Adjuvant therapy could not improve the prognosis of laparoscopic patients (p < 0.05).     

Impact of radical hysterectomy for cervical cancer on urodynamic findings

To elucidate the impact of radical hysterectomy upon the urodynamic findings of patients with cervical cancer, 20 patients with cervical cancer at stage IB to IIA who underwent radical hysterectomy were recruited. Each patient underwent a 20-min pad test and urodynamic study prior to and 3 months after radical hysterectomy. ANOVA, Bonferroni test and paired t -test were utilized for analysis. The mean age of the 20 patients was 50.2±8.7 years with a mean parity of 3.5±1.5. Four (20%) of the 20 cases revealed normal urodynamic findings preoperatively, and the urodynamic findings became abnormal after surgery. Comparing the urodynamic parameters of both bladder voiding and storage functions pre- and post-surgery, we found significant impairments postoperatively in all 20 cases. Our data demonstrate that abnormal urodynamic findings may pre-exist for some patients with cervical cancer prior to surgical treatment. These findings may worsen, and/or additional abnormal states may arise subsequent to radical hysterectomy.Abbreviations GSI Genuine stress incontinence - MUCP Maximal urethral closure pressure - MUP Maximal urethral pressure Editorial Comment: This paper is interesting because of the attempt at getting longitudinal urodynamic data on patients undergoing radical hysterectomy. All diagnosis and data are based on urodynamic findings. The patients serve as their own controls and only 20% were normal before surgery. Urodynamic data are useless in the absence of clinical correlation, and only provide a photographic and not cinematic view of bladder function. I believe it to be critical to include such information to evaluate the value of the information presented if it were to add to our knowledge of bladder dysfunction following radical hysterectomy. Further studies with control groups with no surgery and with regular hysterectomy would add worthwhile information regarding the true impact of radical hysterectomy for cervical cancer on the lower urinary tract function.     

Robotic radical hysterectomy and pelvic lymphadenectomy for uterine rhabdomyosarcoma

Mullerian rhabdomyosarcoma (RMS) is a rare malignancy most commonly diagnosed in childhood and adolescence. RMS of the female genital tract is often difficult to diagnose. Treatment includes chemotherapy with adjuvant surgery and/or radiation therapy reserved for persistent disease. We report a case of an 18-year-old African-American female who presented with severe menometrorrhagia, and was diagnosed with embryonal rhabdomyosarcoma of the uterus. After vincristine, dactinomycin, and cyclophosphamide failed to eradicate the central tumor, she underwent a robotic radical hysterectomy and pelvic lymphadenectomy. Mullerian rhabdomyosarcoma was once managed with multimodality therapy that often included ultraradical surgery including total pelvic exenteration. Surgical procedures that were exclusively performed via large abdominal incisions can now be completed with minimally invasive techniques. Robotic surgery can be safely and successfully applied to radical hysterectomy and lymphadenectomy for uterine rhabdomyosarcoma Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Vaginal-assisted laparoscopic radical hysterectomy: rationale, technique, results

Objective:

Total laparoscopic radical hysterectomy (TLRH) makes it difficult to resect adequate vaginal cuff according to tumor size and to avoid tumor spread after opening the vagina. Laparoscopic-assisted radical vaginal hysterectomy (LARVH) is associated with higher risk for urologic complications.

Methods:

The vaginal-assisted laparoscopic radical hysterectomy (VALRH) technique comprises 3 steps: (1) comprehensive laparoscopic staging, (2) creation of a tumor-adapted vaginal cuff, and (3) laparoscopic transsection of parametria. We retrospectively analyzed data of 122 patients who underwent VALRH for early stage cervical cancer (n=110) or stage II endometrial cancer (n=12) between January 2007 and December 2009 at Charité University Berlin.

Results:

All patients underwent VALRH without conversion. Mean operating time was 300 minutes, and mean blood loss was 123cc. On average, 36 lymph nodes were harvested. Intra- and postoperative complication rates were 0% and 13.1%, respectively. Resection was in sound margins in all patients. After median follow-up of 19 months, disease-free survival and overall survival for all 110 cervical cancer patients was 94% and 98%, and for the subgroup of patients (n=90) with tumors ≤pT1b1 N0 V0 L0/1 R0, 97% and 98%, respectively.

Conclusion:

VALRH is a valid alternative to abdominal radical hysterectomy and LARVH in patients with early-stage cervical cancer and endometrial cancer stage II with minimal intraoperative complications and identical oncologic outcomes.