腹腔镜广泛全子宫切除加盆腔淋巴结清扫术治疗子宫恶性肿瘤安全性分析

The safety analysis of laparoscopic radical hysterectomy and pelvic lymphadenectomy for uterine malignancies

目的探讨子宫恶性肿瘤腹腔镜广泛全子宫切除加盆腔淋巴结清扫术的安全性及并发症的防治。方法对中山大学附属佛山医院1998年8月至2006年1月行腹腔镜广泛全子宫切除加盆腔淋巴结切除术治疗95例子宫颈癌和85例子宫内膜癌的手术时间、术中出血量、淋巴结切除数目、术中及术后并发症临床资料进行回顾性分析。结果中转开腹率1.67%(3/180),手术时间(255±69)min,术中出血量(347±247)mL,淋巴结切除(20±8)个。术中膀胱损伤7例(3.89%),大血管损伤6例(3.33%)。术后并发尿潴留41例(22.78%),淋巴囊肿7例,输尿管瘘2例,膀胱阴道瘘、尿失禁、肠梗阻各1例。结论随着腹腔镜技术的不断熟练和并发症防治技巧的掌握,子宫恶性肿瘤腹腔镜下广泛全子宫切除加盆腔淋巴结切除有望成为一种极具潜力的手术方式。

Objective To evaluate the safety and feasibility of laparoscopic radical hysterectomy （LRH） and pelvic lymphadenectomy in the treatment of uterine malignancies. Methods A retrospective study was conducted on LRH and pelvic lymphadenectomy in 95 cases of cervical carcinoma and 85 cases of endometrial carcinoma at the Affiliated Foshan Hospital of Sun Yat-sen University from Aug. 1998 to Jan. 2006. The operative time,intraoperative blood loss, number of lymph nodes excised and complication rate were retrospectively analyzed. Results The conversion rate to laparotomy was 1.67% （ 3/180）, the mean operative time was （ 255 ± 69 ） min, and the mean operative blood loss was （ 347 ±247 ） mL. The average number of pelvic lymph nodes excised was （ 20 ±8 ）. There were 7 cystomys （ 3.89 % ） and 6 （ 3.33 % ） blood vessel injuries. Postoperative complications included 41 bladder retentions （22.78 % ） , 7 lymphocysts, 2 urethral fistulas, 1 bladder fistula, 1 urine incontinence and 1 bowel obstruction. Conclusion The outcome of our research suggests that the laparoscopic radical hysterectomy combined with pelvic lymphadenectomy is a safe and effective alternative to conventional abdominal surgery＇ for uterine malignancy, and should be used if the surgeon is sufficiently trained and masters the tips to prevent the complication.