腹腔镜淋巴结切除治疗妇科恶性肿瘤的价值

Value of laparoscopic lymphadenectomy in treatment of gynecology malignancies

目的 探讨腹腔镜下广泛子宫切除和盆腹腔淋巴结切除用于妇科恶性肿瘤的效果及价值。方法 于 2 0 0 0年 7月至2 0 0 1年 5月期间 ,采用腹腔镜下广泛子宫切除和盆腔及腹主动脉周围淋巴结切除治疗了 2 1例经活检证实的早期妇科恶性肿瘤患者 ,其中子宫内膜癌 1 2例 ,子宫颈癌 9例。所有腹腔镜手术均根据病变部位和淋巴结切除术适应症 ,行盆腔淋巴结切除术 ,部分病例行选择性腹主动脉周围内淋巴结切除 ,再行腹腔镜辅助阴式广泛子宫切除术。结果 腹腔镜下平均手术时间为 3 7h。术中出血平均 2 1 6ml。切除的淋巴结数平均 1 9个。术后住院 5 6d。所有病例术中未发生肠道、膀胱和输尿管损伤。 1例于术后 1月出现双侧输尿管轻度狭窄外 ,其余病例无明显并发症发生。结论 腹腔镜下施行恶性肿瘤广泛子宫切除和盆腹腔淋巴结切除术是安全可行的 ,其分期可靠、准确 ;且手术创伤小 。

Objective To investigate the efficacy and value of laparoscopic radial hysterectomy and lymphadenectomy in patients with gynecology malignancies. Methods Laparoscopic radial hysterectomy and lymphadenectomy were performed on 21 biopsy proven patients at early stage of cancer (12 endometrial cancer and 9 cervical cancers) from July 2000 to May 2001. Pelvic, para aortic, or combined the 2 lymphadenectomy were carried out according to the primary site of the disease and indication. Radical hysterectomy was laparoscopically done immediately if residual nodes were negative. Results Laparoscopy had an average operation time of 3.7 h, and average blood loss of 216 ml. The average number of resected nodes was 19 in those 21 patients. The patients undergoing laparoscopic assisted vaginal radical hysterectomy or lymphadenectomy were admitted for 5.6 d on average. There were no major intraoperative complications, such as damage of the intestinal tract, bladder and ureter. No patient was converted to abdominal surgery. No obvious postoperative complications occurred except one having slight ureteral constriction 1 month after operation. Conclusion Laparoscopic assisted vaginal radical hysterectomy and lymphadenectomy was feasible and safe in the treatment of cervical or endometrial cancers with the advantages of less invasiveness and reduced recovery time. This is a reliable and accurate method for staging cervical or endometrial carcinoma.