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

Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy for Uterine Malignancy:Report of 11 Cases

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。

Objective To explore the feasibility and efficacy of radical hysterectomy and pelvic lymphadenectomy under laparoscope for the treatment of early-stage malignant uterine tumors. Methods From March 2007 to March 2008, 11 patients with cervical cancers received radical hysterectomy and pelvic lymphadenectomy by laparoseopy in our hospital. Meanwhile, 26 patients with uterine malignancy underwent same treatments by open surgery. The clinical data including the operation time, intraoperative blood loss, the number of resected lymph nodes, postoperative morbidity, recovery time of gastrointestinal function, and hospital stay were compared between the two groups. Results In the laparoscopy group, 3 cases of adenoeareinoma endometrium （ ⅠB 2, Ⅱ A 1 ） and 8 cases of squamous carcinoma of the cervix （ ⅠA 1 , ⅠB 5, ⅡA 2） were confirmed; while in the open surgery group, 7 cases of adenocarcinoma endometrium （ ⅠB 5, ⅡA 2） and 19 cases of squamous carcinoma of the cervix （ ⅠA 2, ⅠB 14, ⅡA 3 ） were diagnosed, showing no significant difference between the two groups （P 〉 0.05）. Compared to the open surgery group, the laparoscopy group had less intraoperative blood loss [ （216.8±125.4） ml vs （402.1±135.2） ml, t = - 3. 889, P = 0. 000] , more resected lymph nodes [（19.9 ±6.5） nodes vs （14.6±5.6） nodes, t =2.510, P=0.017], early evacuation [（34.6 ±6.5）h vs （56.4± 7.6） h, t= -8.300, P=0.000], and shorter hospital stay [（14.6±3.5） d vs （19.4±5.6） d, t = -2.622, P=0.013]. No significant difference was found in the operation time, postoperative morbidity, and the incidence of urinary retention between the two groups （P 〉 0.05）. The mean follow-up of the two groups was （11.0 ± 3.2） months and （12.0 ±2..8） months respectively; no evidence of recurrence was detected during the period. Conclusion Laparoscopy is minimally invasive, safe and effective for uterine malignancy.