腹腔镜与开腹手术治疗早期子宫内膜样腺癌的临床研究

Comparative analysis of laparoscopic surgery and laparotomy for early stage endometrioid adenocarcinoma

背景与目的:研究显示腹腔镜手术治疗子宫内膜癌是安全可行的,尤其是对早期患者。本文分析腹腔镜手术治疗早期子宫内膜样腺癌的临床资料,探讨应用腹腔镜手术治疗早期子宫内膜样腺癌的临床效果。方法:回顾性分析本科室于2005年1月—2010年7月间收治的具有完整资料的早期子宫内膜样腺癌行腹腔镜手术的患者42例,选择同期经开腹手术治疗的早期子宫内膜样腺癌患者42例进行对照,观察两组患者围手术期的各项指标和术后疗效。结果:两组患者年龄、体重、术前病理分化程度和肌层浸润深度差异均无统计学意义(P>0.05)。腹腔镜组与对照组平均手术时间(110和136min)、手术出血量(52和65mL)、平均切除盆腔淋巴结数(15.6和16.2个)、病理类型和手术病理分期差异均无统计学意义(P>0.05);术后平均住院天数分别为4.5和8.2d,差异有显著的统计学意义(P<0.001)。两组术后并发症发生率(4.76%和14.29%)、术后病率发生率(7.1%和38.10%),差异均有统计学意义(P<0.05)。两组术后总生存率均为97.62%,无瘤生存率分别为92.86%和95.24%,差异均无统计学意义(P>0.05)。结论:腹腔镜手术创伤小、术中出血量少、术后并发症少、术后恢复快、近期疗效满意,是治疗早期子宫内膜样腺癌较好的手术方式,但其远期治疗效果及长期预后需进一步研究。

Background and purpose：As experience in laparoscopic surgery for the management of endometrial cancer continues to accumulate,an increasing amount of articles supported it＇s advantage.Due to the increase of information,we evaluated the clinical outcome of laparoscopic surgery in patients with early stage endometrioid adenocarcinoma in our hospital.Methods：From Jan.2005 to Jul.2010 in Jiao Tong University Xinhua Hospital,42 cases of early stage endometrioid adenocarcinoma treated by laparoscopy were retrospectively analyzed and compared with the patients who received laparotomy.Clinical data from the two groups were compared.Results：The clinicopathological characteristics in both groups before the operation were similar.The mean operating time in the laparoscopy group （110 minutes） was signifi cantly shorter （P0.05） than that in the laparotomy group （136 minutes）.The blood loss during the operation in the laparoscopy group （52 mL） was also less than that in the laparotomy group （65 mL）.The number of lymph nodes resected between the two groups were similar.The complication rate in the laparoscopy group （2 cases,4.76%） was lower than that in the laparotomy group （6 cases,14.29%） （P0.05）.The laparoscopy group required fewer hospitalization （4.5 days） than that of the laparotomy group （8.2 days） （P0.001）.Postoperative pathological type and the International Federation of Gynecology and Obstetrics （FIGO） stages between the two groups were similar.The overall survival rate and disease free survival rate were similar.Conclusion：Laparoscopic surgery is a minimally invasive surgery for the early stages of endometrioid adenocarcinoma due to its shorter operation time,lesser blood loss and fewer postoperative complications.However,the long term prognosis of patients still needs to be studied by multicenter randomized clinic tria1.