老年妇科肿瘤患者应用腹腔镜手术的临床研究

Clinical experience with laparoscopic surgery in elderly patients with gynecologic tumors

目的探讨腹腔镜手术应用于老年妇科肿瘤患者的临床经验。方法回顾性分析2003年1月至2008年12月于复旦大学附属妇产科医院行腹腔镜手术且年龄65岁及以上的老年患者136例，记录其病理类型、手术方式、合并症等临床特点。结果136例患者中，子宫肌瘤23例（16．9％），子宫内膜样腺癌49例（36．0％），卵巢肿瘤63例（46．3％），输卵管浆液性腺癌1例（0．7％）。腹腔镜辅助的阴式子宫切除及双附件切除术120例，腹腔镜辅助的阴式子宫及双附件切除术＋盆腔淋巴结清扫术3例，双侧附件或单侧附件切除术5例，8例患者获得病理冰冻切片结果后中转为经腹分期手术。恰当的手术范围与缩短手术时间、减少术中出血量及术后住院时间相关。结论老年妇科肿瘤患者须经过严格的术前检查、恰当的围手术期处理，术者需具备熟练的手术技术，才能有效提高腹腔镜手术的安全性。

Objective To explore clinical experience of laparoscopic surgery in aged women with gynecologic tumors. Methods 136 women aged 65 years or older were included in the study, who received gynecologic laparoscopic surgeries under general anesthesia in this hospital from January 2003 to December 2008. Comorbidity, physical examination findings, operating time, blood loss, complications and hospitalization were analyzed. Results Of the 136 cases, 23 cases were hysteromyoma （16.9%）, 49 cases were endometrial carcinoma （36.0%）, 63 cases were ovarian tumor （46.3%）, and one case was carcinoma of fallopian tube （0.7 %）. 120 cases underwent laparoscopy-assisted vaginal hysterectomy （LAVH）, 5 cases underwent bilateral salphingo-oophorectomy （BSO）, 3 cases underwent LAVH＋BSO＋pelvic lymphadenectomy, and 8 cases were converted to laparotomy after getting the frozen section reports. The mean operating time, blood loss and postoperative hospital stay were correlated with appropriateness of the procedure. Conclusion Aging is not a contradiction of gynecologic laparoscopic surgery. With full and appropriate evaluation and preparation, gynecologic laparoscopic surgery is safe and feasible for gynecologic oncology.