腹腔镜辅助小切口宫颈癌根治术临床研究

Laparoscopic-assisted Mini-incision Radical Hysterectomy for Cervical Cancer

目的探讨腹腔镜辅助小切口宫颈癌根治术的可行性。方法 2009年1月～2010年7月,施行宫颈癌根治术24例,其中开腹13例,腹腔镜辅助小切口11例。2组年龄、术前分期差异无显著性(P>0.05)。比较2组手术时间、术中出血量、切除淋巴结数量、术后恢复情况及手术并发症。结果 2组均顺利完成手术。与开腹组相比,腹腔镜辅助组清扫淋巴结数量差异无显著性[(24.5±5.5)个vs.(26.1±3.9)个,t=-0.807,P=0.428],术中出血量少[(296.7±42.1)ml vs.(594.4±87.7)ml,t=-10.878,P=0.000],术后排气时间早[(1.9±0.4)d vs.(2.8±0.6)d,t=-4.386,P=0.000],下床活动时间早[(2.1±0.5)d vs.(3.6±0.7)d,t=-6.110,P=0.000],术后住院时间短[(12.2±3.3)d vs.(17.6±4.8)d,t=-3.254,P=0.004],但手术时间长[(233.2±23.5)min vs.(215.6±11.9)min,t=2.247,P=0.035]。结论腹腔镜辅助小切口宫颈癌根治术出血少,术后恢复快,安全可行。

Objective To study the feasibility of laparoscopic-assisted mini-incision radical hysterectomy for cervical cancer.Methods Between January 2009 and July 2010,we implemented radical hysterectomy on 24 patients with cervical cancer,including 13 cases of radical abdominal hysterectomy and 11 cases of laparoscopic assisted mini-incision radical hysterectomy.Operation time,intraoperative blood loss,number of dissected lymph nodes,recovery and complications after the surgery were compared between the two groups. Results No significant difference existed in preoperative staging and age between the two groups（P0.05）.All the patients went through the operation successfully.No significant difference was detected between the two groups in the number of dissected lymph nodes（24.5±5.5 vs.26.1±3.9,t=-0.807,P=0.428）.Laparoscopic-assisted group showed significantly less blood loss [（296.7±42.1） ml vs.（594.4±87.7） ml,t=-10.878,P=0.000],and significantly earlier postoperative ambulation than laparotomy group [（2.1±0.5） d vs.（3.6±0.7） d,t=-6.110,P=0.000].The recovery of gastrointestinal function in laparoscopic group was significantly earlier than laparotomy group [（1.9±0.4） d vs（2.8±0.6）d,t=-4.386,P= 0.000].Laparoscopic group had significantly shorter postoperative hospital stay than that in laparotomy group [（12.2±3.3） d vs.（17.6±4.8） d,t=-3.254,P=0.004],but significantly longer operation time [（233.2±23.5） min vs.（215.6±11.9） min,t= 2.247,P=0.035].Conclusion It is safe and feasible to treat cervical cancer with laparoscopic assisted mini-incision radical hysterectomy,which can reduce blood loss and promote rehabilitation.