经阴道子宫广泛切除联合腹腔镜手术治疗子宫恶性肿瘤的临床研究

Clinical Study of Laparoscopic Pelvic Lymphadenectomy Assisted Radical Vaginal Hysterectomy(LARVH)in the Treatment of Uterine Neoplasm

目的：探讨经阴道子宫广泛或次广泛切除加腹腔镜手术治疗子宫恶性肿瘤的可行性和临床效果。方法：对18例宫颈癌患者,5例子宫内膜癌患者,行经阴道子宫广泛或次广泛切除加腹腔镜盆腔淋巴结清除术。分析手术质量和术后恢复情况。结果：23例患者均顺利完成手术,无并发症发生。清除的盆腔淋巴结数平均29个,平均手术时间为216分钟,术中平均出血350 ml,3例需要输血。术后肛门排气时间平均1．8天,膀胱功能恢复时间平均11．5天,平均术后住院时间9．5天。术后第一天均可下地活动。22例无复发。结论：该术式损伤小、恢复快,能达到足够的切除范围,是目前治疗子宫恶性肿瘤较理想的术式。

Objective： To discuss dinical effect and feasibility of laparoscopic pelvic lymphadenectomy assisted radical vaginal hysterectomy （LARVH） or sub-hysterectomy in the trealment of uterine neoplasm. Methods： Laparoscopic pelvic lymphadenectorny assisted Radical Vaginal Hysterectomy or sub-hysterectomy was performed in 18 cervical cancers and 5 endometrial cancers. The operative quality and postoperative recovery condition were analyzed. Results：23 patients all successfully accomplished LARVH with no complications.The standard radical hysterectomy or sub-hysterectomy were performed in all of petients, them were average 29 pelvic lymph nodes be removed. The average duration of surgery was 216 min and average hemorrhage was 350 ml. There were 3 patients needed blood transfusion during operation.After operation,the mean time for passage of gas by anus was 1.8 days, and the mean recovery time of bladder function was 11.5 days. Patients were discharged after 9.5 days on average. After a followup time of 3 - 24 months, excepted 1 multicentre cancer patient with in situ squamo-carcinome at vaginal superior segment, other 22 patients had no recurrence. Conclusions： For the treatment of uterine neoplasm, LARVH decreased operative damage with shodly recovery time, same operative extent as Laparotomy. It is an ideal way to treat uterine neoplasm currently.