腹腔镜辅助阴式子宫广泛切除术在子宫恶性肿瘤中应用的临床疗效

Clinical Effects of Laparoscopic Assisted Radical Vaginal Hysterectomy in the Treatment of Uterine Neoplasm

目的探讨腹腔镜辅助阴式子宫广泛切除术(LARVH)在子宫恶性肿瘤中的临床疗效。方法选择2010年10月至2011年10月本院收治的20例子宫恶性肿瘤患者为研究对象,对其行LARVH+盆腔淋巴结清扫术(LARVH组)。随机抽取2009年5月至2011年10月因子宫恶性肿瘤行传统开腹手术的38例患者纳入对照组(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书)。采用统计学方法分析手术疗效、患者术后恢复及随访情况。结果 LARVH组20例患者手术顺利,术中出血量为(150～350)mL,术后肛门排气时间为(1.0～2.5)d,术后盆腔引流量为(125～350)mL,膀胱功能恢复所需时间为(12～30)d,住院时间为(14～20)d,术后拆线时间为(5～7)d,以上临床资料与对照组比较,差异均有统计学意义(P<0.05)。所有患者术后第2天均可下地活动,无一例伤口出现脂肪液化感染。LARVH组手术时间[(210～320)min]、阴道切除长度[(3.0～4.0)cm]方面与对照组比较,差异均无统计学意义(P>0.05)。对LARVH组患者随访(3～14)个月显示,术后残端愈合良好,无一例复发及并发症发生。结论 LARVH在子宫恶性肿瘤中的应用是否切实可行,尚需大样本、多中心前瞻性随机对照研究进一步研究证实。

Objective To evaluate the clinical effects of laparoscopic assisted radical vaginal hysterectomy （LARVH） in the treatment of uterine neoplasm. Methods LARVH was performed in 20 patients with uterine neoplasm （LARVH group） from October 2010 to October 2011 in the department of Obstetrics and Gynecology, Mianyang People＇s Hospital. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Mianyang People＇s Hospital. Informed consent was obtained from each participate. Meanwhile, 38 patients was performed radical abdominal hysterectomy （RAH）, from May 2009 to October 20tl were included into control group. The operative quality, postoperative recovery condition and long-term follow-up were analyzed. Results All the patients of （LARVH group） accomplished the LARVH with no complications. The hemorrhage was 150 mL to 350 mL. After the operation, the passage of gas by anus was 1.0 to 2.5 days, the pelvic fluid was 125 mL to 350 mL,the recovery time of bladder function was 12 to 30 days, the hospitalized time was 14 to 20 days, the incision suture removal was 5 to 7 days, all patients can get up at the next day,no case appeared poor healing wound. There was significant difference between LARVH group and control group （P〈 0. 05）. There was no significant difference between two groups in the following items, surgery duration [-（210~ 320） mini, the length of vagina [（3.0-4.0） cm] （P〉0.05）. The follow up lasted 3-14 months which showed all the patients had no recurrence. Conclusions LARVH practicability of uterine neoplasm still need to be proved by more large scale, multi-center prospective randomized controlled trails in the further.