腹腔镜下广泛子宫切除和盆腔淋巴结清扫术治疗早期宫颈癌与开腹手术的比较分析

A comparative study between laparoscopic radical hysterectomy combined with pelvic lymphadenectomy and conventional abdominal radical hysterectomy in the treatment of early cervical cancer

目的探讨腹腔镜广泛子宫切除术治疗早期宫颈癌的可行性、安全性、并发症和生存率。方法对接受腹腔镜手术（107例）和剖腹手术（126例）治疗的临床ⅠA1-ⅡA期宫颈癌患者的临床资料及随访情况进行回顾性分析。对接受腹腔镜手术的患者和开腹手术的患者术中情况、并发症和生存率进行比较。结果腹腔镜组全部在腹腔镜下完成,前50例腹腔镜平均手术时间（284.4±31.7）min,较开腹手术时间（221.3±24.6）min长（P〈0.01）,后57例腹腔镜平均手术时间（229.9±29.7）min较前50例明显缩短,与开腹手术时间差距有统计学意义（P〈0.05）,腹腔镜术中平均出血量（125.2±49.1）mL较开腹术中平均出血量（306.3±99.2）mL明显减少,腹腔镜平均切除淋巴结数21.0（6-42）个较开腹平均切除淋巴结数22.1（8~40）个差距无统计学意义,腹腔镜术后膀胱功能恢复时间为（13.9±5.4）d较开腹术后膀胱恢复时间[（14.6±6.1）d]比较无统计学意义。术后并发症：腹腔镜组术后尿储留2例,分别于术后41 d及47 d拔除导尿管,单纯淋巴囊肿3例,发生膀胱阴道瘘1例,剖腹组损伤右侧髂总静脉1例,术后尿潴留4例,淋巴囊肿2例,伤口感染2例,腹壁切口疝2例。腹腔镜组与剖腹组比较生存率分别为95.3%与93.7%。结论腹腔镜下广泛性子宫切除及盆腔淋巴结清扫术可作为早期子宫颈癌手术治疗的方法之一。

Objective To explore the feasibility,safety,complications and survival outcomes of laparoscopic radical hysterectomy（LRH） as primary surgical approach for early cervical cancer.Methods A total of 233 women with stageIA1-ⅡA early cervical cancer underwent surgery,107 of whom underwent LRH and 126 of whom underwent conventional abdominal radical hysterectomy（CARH）.Their clinical data and follow-ups were retrospectively analyzed.The intraoperative conditions,complications and survival rate were compared.Results All surgeries of the LPH group were conducted under laparoscope.The average surgery duration was（284.4±31.7） min in the first 50 patients,which was longer than the（221.3±24.6） min in the CARH group.Surgery duration of the next 57 patients in the LRH group was shorter than the first 50 patients,but longer than patients in the CARH group.The difference was statistically significant（P〈0.05）.Blood loss in the LRH group was（125.2±49.1） mL which was less than that in the CARH group（306.3±99.2） mL.The number of pelvic nodes was 21.0（6-42） in the LRH group which showed no statistical significance with 22.1（8-40） in the CARH group.Time to return bladder functions was（13.9±5.4） d in the LRH group which showed no statistical significance with the（14.6±6.1） d in the CARH group.The results of postoperative complications were as follows.Two patients had urinary retention,whose catheters were extubated on the 41st and 47th day,three patients had lymphocystis,and one patient had vesicovaginal fistula in the LRH group.One patient had right common iliac vein injury,4 patients had urinary retention,2 patients had lymphocystis,2 patients had incision infections and another 2 patients had abdominal incisional hernia in the CARH group.The survival rates of the two groups were 95.3% and 93.7%,respectively.Conclusion Laparoscopic radicalhysterectomy combined with pelvic lymphadenectomy can be one of the approaches for early cervical cancer.