腹腔镜下宫颈癌根治术30例临床分析

Laparoscopic radical resection in the treatment of cervical carcinoma： clinical analysis of 30 cases

目的探讨腹腔镜下宫颈癌根治术f临床疗效。方法选取西安交通大学医学院第-附属医院2010年3月至2012年10月收治的58例宫颈癌患者，30例患者行腹腔镜下根治术和盆腔淋巴结清扫术治疗（腔镜组），28例患者行开腹子宫切除术和盆腔淋巴结清扫术治疗（开腹组）。对比两组的手术时间、术中出血量、淋巴结清扫个数、术后住院时间及术后并发症发生情况。结果腔镜组手术时间（176．8±51．3）分钟，术中出血量（128．7±34．1）mL，平均淋巴清扫个数为（22．3±1．6）个，术后住院时间（7±3）天；开腹组手术时间（173．1±56．9）分钟，术中出血量（163．5±41．2）mL，平均淋巴清扫个数为（21．5±1．8）个，术后住院时间（16±5）天。两组患者的手术时间和淋巴结清扫个数差异无统计学意义（t值分别为0．260和1．792，均P〉0．05）；腔镜组术中出血量、术后住院时间显著低于开腹组（t值分别为-3．514和-8．377，均P〈0．05）。术后腔镜组有1例患者发生尿潴留，1例发生下肢静脉血栓；开腹组患者3例发生尿储留，1例发生下肢静脉血栓，2例发生腹部切口感染并行二次缝合。结论腹腔镜下宫颈癌根治术对患者创伤较小，术中出血量较少，术后恢复较快，可减少住院时间。

Objective To investigate the clinical curative effect of laparoscopic radical resection in the treatment of cervical carcinoma. Methods From March 2010 to October 2012 there were 58 cases of cervical carcinoma treated in First Affiliated Hospital of Medical College. Thirty of them were treated with laparoscopic radical resection and radical dissection of pelvic lymph node （ experiment group） , and the other 28 were treated with abdominal hysterectomy and radical dissection of pelvic lymph node （ control group ）. The operation time, intraoperative blood loss, number of lymph node cleaned, postoperative hospital stay and postoperative complications were compared between two groups. Results In the experiment group the operation time was 176.8 ± 51.3 minutes, intraoperative blood loss was 128.7 ±34.1 mL, the number of lymph node cleaned was 22.3 ± 1.6, and postoperative hospital stay was 7 ± 3 days. In the control group, the operation time was 173.1 ±56.9 minutes, intraoperative blood loss was 163.5 ±41.2 mL, the number of lymph node cleaned was 21.5± 1.8, and postoperative hospital stay was 16 ± 5 days. There were no significant differences in operation time and number of lymph node cleaned between two groups （ t value was 0. 260 and 1. 792, respectively, both P 〉 0. 05 ） , but the intraoperative blood loss and postoperative stay in experiment group were significantly less than those in control group （ t value was - 3.514 and - 8. 377, respectively, both P 〈 0.05 ）. There was one case of urinary retention and another case of lower limb venous thrombosis in experiment group, while there were three cases of urinary retention, one case of lower limb venous thrombosis and two cases of incision secondary closure in control group. Conclusion In the treatment of cervical carcinoma, laparoscopie radical resection has the characteristics of mild trauma, less intraoperative blood loss, faster recovery and shorter hospital stay .