腹腔镜辅助阴式子宫广泛切除术治疗宫颈癌的临床研究

Laparoscopic-assisted radical Vaginal Hysterectomy to Treat Cervical Cancer Clinical Study

目的探讨运用微创手术治疗宫颈癌的安全性及可行性,推广阴式及腹腔镜等微创手术技术治疗妇科恶性肿瘤。方法收集2009年3月～2012年7月北京医院妇科宫颈癌入院手术患者共66例,其中行开腹宫颈癌根治术(RAH)33例,腹腔镜辅助阴式广泛子宫切除术(LARVH)33例,各组按照分期Ⅰa2～Ⅲ期(FIGO 2009分期)。研究两组手术切除范围、病理结果、术中情况及术后短期并发症。运用SPSS 17.0软件进行对比分析。结果 LARVH组切除阴道长度明显长于RAH组,两组切除宫旁范围无明显差异。RAT组切除淋巴结个数明显多于LARVH组,但两组淋巴结阳性率及切缘阳性率等高危因素无明显差异。LARVH组术中出血及输血量明显少于RAH组,两组手术时间长度术中、术后并发症发生无明显差异。LARVH组术后住院时间及排气排尿时间明显比RAH组短。结论 LARVH与RAH不仅手术切除效果等同,并且LARVH治疗宫颈癌相比RAH出血少,患者术后恢复快,是宫颈癌根治术的另一有效手段。但因术后观察时间短,对于生存率及复发率需进一步观察研究。

Objective The purpose of this study is to compare the safety, efficacy of laparoscopic - vaginal radical hysterectomy （LVRH） versus abdominal radical hysterectomy （ARH） in the treatment of cervical cancer, and explore the potential benefits of advanced laparoscopic techniques / lymphadenectomy / with vaginal operation in the treatment of gynecological malignant tumors. Methods We compared retrospectively the results of laparoscopic - vaginal radical hysterectomy and abdominal radical hysterectomy operations in the stage I a2 to Ⅲ （FIGO 2009） cervical cancer patients treated at the Department of Obstetrics and Gynecology Beijing Hospital from March 1, 2009 to July 31,2012. We analyzed the results of 66 patients in this period, 33 patients underwent a laparoscopic - vaginal rad- ical hysterectomy （LVRH） , 33 patients underwent a abdominal radical hysterectomy （ARH）. Both LVRH and ARH groups were compa- rable in terms of surgical technique, result of the pathology, operative and postoperative situation and short - term complications. Results The length and area of vaginal excision was significantly greater in LVRH group. The tissue excision of parametrum was similar in both groups. The number of lymph nodes obtained from ARH was more than that in LVRH group. The number of lymphatic metastasis and pos- itive surgical margin were no significantly different in both groups. The blood loss and blood transfusion were significantly less in LVRH than ARH patients. Median operating time, the rate of complications in operation and postoperation were similar in both groups. The hos- pital stay was significantly shorter in LVRH group. Conclusion We consider that laparoscopic - vaginal radical hysterectomy （LVRH） for the treatment of early cervical cancer is a safe and effective alternative to conventional ARH in term of less blood loss and sooner recov- ering time. It could be a valuable element in broadening the spectrum of many kinds of operations used in treatment of cervical cancer. This is a retrospective study, we are still looking forward the data of the long - term outcomes, considering the higher recurrence rate of cervical cancer.