早期子宫内膜癌腹腔镜下分期手术的临床可行性及效果分析

Clinical feasibility and effect of laparoscopic staging surgery for early endometrial carcinoma

目的探讨腹腔镜分期手术治疗早期子宫内膜癌的临床效果及可行性。方法选取2012年6月至2014年1月江油市人民医院妇产科手术治疗的130例早期子宫内膜癌患者进行回顾性分析,其中67例患者采取腹腔镜分期手术治疗(腹腔镜组)、63例患者采取开腹分期手术治疗(开腹组),对比两组患者的手术相关指标、手术并发症及手术前后患者免疫指标的变化。结果腹腔镜组患者的手术时间显著的长于开腹组患者,差异具有统计学意义(t=6.832,P<0.001),腹腔镜组患者的手术出血量、术后排气时间、导尿管留置、住院时间均显著的低于开腹组患者,差异具有统计学意义(t值分别为12.981、9.083、2.279、5.182,均P<0.05),两组患者淋巴结清扫数目差异不具有统计学意义(t=1.461,P=0.073>0.05);术后3d,腹腔镜组患者的CD4+/CD8+显著的高于开腹组患者,血清肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、白细胞介素-6(IL-6)水平显著的低于开腹组患者,差异具有统计学意义(t值分别为5.017、17.982、5.352、7.880,均P<0.001);腹腔镜组患者的手术并发症率16.42%与开腹组患者的19.05%差异不具有统计学意义(χ2=0.473,P=0.491>0.05)。结论腹腔镜分期手术治疗早期子宫内膜癌较开腹手术创伤小、恢复快、对患者免疫水平及炎症水平影响小。

Objective To investigate the clinical effect and feasibility of laparoscopic staging surgery for early endometrial carcinoma . Methods From June 2012 to January 2014 in People ’ s Hospital of Jiangyou City 130 patients with early endometrial carcinoma were retrospectively analyzed , of which 67 cases undergoing laparoscopic staging surgery （ laparoscopic group ） and 63 cases treated by laparotomy staging surgery （open group）.Operation related indexes, surgical complications and immune indices before and after surgery were compared between two groups .Results The operation time of laparoscopic group was significantly longer than that in open group （ t=6.832, P〈0.001）.Surgical bleeding, postoperative exhaust time, indwelling catheter and hospitalization time were significantly lower in laparoscopic group （t value was 12.981, 9.083, 2.279 and 5.182, respectively, all P〈0.05）.Difference in lymph node dissection number was not statistically significant （t=1.461, P=0.073 〉0.05）.Three days after surgery, CD4 ＋/CD8 ＋level of patients in laparoscopic group was significantly higher than that in open group , but serum TNF-α, PCT and IL-6 were significantly lower with significant differences （ t value was 5.017, 17.982, 5.352 and 7.880, respectively, all P 〈0.001 ）.The complication rate in laparoscopic group （19.05%） was not significantly different from that of open group （16.42%） （χ2 =0.473, P=0.491 〉0.05）. Conclusion Laparoscopic staging surgery for early endometrial carcinoma has the characteristics of mild invasion , fast recovery and little influence on immune level and inflammation level .