腹腔镜淋巴结清扫术在早期妇科肿瘤肥胖患者中的应用

目的:评价腹腔镜广泛子宫切除术加双侧盆腔、腹主动脉旁淋巴结清扫术治疗妇科恶性肿瘤患者的应用价值。方法:回顾分析2009年6月至2013年9月为20例子宫内膜癌、宫颈癌患者行腹腔镜手术的临床资料,观察手术时间、术中出血量、切除淋巴结数量、术后肛门排气时间及术后并发症等指标,并与同期开腹手术进行对比分析。结果:20例腹腔镜手术均顺利完成,无一例中转开腹。两组手术时间、术中失血量、术后肛门排气时间、术后下床活动时间、切口感染或脂肪液化率差异均有统计学意义(P<0.01),清扫淋巴结数量、宫旁或阴道切除范围差异无统计学意义(P>0.01)。术后随访2~3年,两组患者均无复发。结论:相较传统开腹手术,腹腔镜手术具有患者创伤小、并发症少、术后康复快等优点,腹腔镜广泛子宫切除术加盆腔淋巴结切除术治疗肥胖早期妇科恶性肿瘤患者是安全、可行的。

The application of laparoscopic lymphadenectomy for early stage gynecologic malignant tumor in obese patients

Objective：To evaluate the application value of laparoscopic extensive hysterectomy and pelvic lymph node dissection and para-aortic lymph node dissection in the treatment of patients with gynecologic malignant tumor. Methods： The clinical data of 20 patients with endometrial cancer and cervical cancer who underwent laparoscopic surgery between Jun. 2009 and Sep. 2013 were retrospectively analyzed. The operation time, intraoperative blood loss, the number of excised lymph nodes, postoperative exhaust time and postoperative complications were recorded and compared with those of open operations during the same period. Results： All the laparoseopie operations were successfully performed without any conversion to laparotomy. The average operation time, intraoperative blood loss, postoperative anal exhaust time, postoperative ambulation time, the rate of incision infection or fat liquefaction after surgery had statistically significant difference between the two groups （P 〈 0.01 ）. However, there were no statistical differences in the number of excised lymph nodes and the range of parametrium or vaginal resection （P 〉 0.01 ）. During a follow-up of 2-3 years, there was no recurrence in both groups. Conclusions：Compared with traditional open surgery, laparoscopic surgery has the advantage of smaller trauma, fewer complications and quicker recovery. Laparoscopie hysterectomy and pelvic lymph node dissection for the treatment of obese patients with early stage gynecologic malignant tumor is safe and feasible.