腹腔镜与开腹手术治疗早期宫颈癌的临床疗效比较

Comparison of clinical efficacy on laparoscopic and laparotomic surgery in treating early stage cervical carcinoma

目的:比较腹腔镜与开腹手术治疗早期宫颈癌的临床疗效,探讨腹腔镜治疗宫颈癌的手术技巧和并发症的防治。方法:选择75例早期宫颈癌患者行腹腔镜(腹腔镜组,37例)和开腹(开腹组,38例)广泛全子宫切除术及盆腔淋巴结清扫术。观察两组患者手术时间、术中出血量、切除盆腔淋巴结数量、术后肛门排气时间、术后住院时间和并发症等情况。结果:腹腔镜组术中出血量(320.7±50.2)ml,少于开腹组的(354.6±65.3)ml;术中切除盆腔淋巴结(24.7±4.3)个,多于开腹组的(19.5±3.7)个;术后肛门排气时间为(48.2±7.6)h,早于开腹组的(60.6±11.2)h;术后住院时间(7.6±2.2)d,短于开腹组的(10.6±2.4)d;并发症发生率13.50%(5/37)低于开腹组的21.05%(8/38),两组比较差异均有统计学意义(均P<0.05);但腹腔镜组手术时间(240.4±78.3)min长于开腹组(169.3±45.9)min(P<0.01)。术后病理学检查均未发现切缘有残余病灶。所有患者均随访1～52个月,无肿瘤复发和穿刺点转移。结论:腹腔镜下广泛全子宫切除术及盆腔淋巴结清扫术,能完全达到开腹手术的要求,手术创伤小、恢复快,临床疗效明显优于开腹手术,是一种治疗早期宫颈癌的理想方法。

Objective：To compare the clinical efficacy on laparoscopic and laparotomic surgery in treating early stage cervical carcinoma,and to investigate the surgical techniques of laparoscopic for cervical cancer and prevention treatment of complications.Methods：75 patients with early cervical cancer who were treated with laparoscopic surgery（laparoscopy group,37 cases） and laparotomic surgery（laparotomy group,38 cases） extensive hysterectomy and pelvic lymph node dis section.The patients of two groups were observed with operation time,blood loss,number of pelvic lymph node resection,anal exhaust time,postoperative hospital stay and complications,etc.Results：Laparoscopy group,blood loss（320.7±50.2） ml was less than laparotomy group（354.6±65.3） ml;pelvic lymph node excision（24.7±4.3） was more than laparotomy group（19.5±3.7）;anal discharge（48.2±7.6） h was earlier than that in the laparotomy group（60.6±11.2） h;postoperative hospital stay（7.6±2.2） d was shorter than the laparotomy group（10.6±2.4） d and complication rate 13.50%（5/37） was lower than the laparotomy group 21.05%（8/38）.There were significant diffenences（all P〈0.05）.But in the laparoscopy group,the operative time（240.4±78.3） min was longer than the laparotomy group（169.3±45.9） min（P〈0.01）.Pathological examination after surgical margins were followed after the operation and were found no focus in a residual lesion.All patients were fol lowed up for 1-52 months,and there was no tumor recurrence and metastasis puncture.Conclusion：Laparoscopic extensive hysterectomy and pelvy lymph node dissection can fully meet the requirements of laparotomy,minor trauma,rapid re covery,clinical efficacy is superior to laparotomy surgery,laparoscopic is an ideal method for the treatment of early cervical cancer.