腹腔镜辅助阴式手术与单纯腹腔镜手术治疗子宫内膜癌临床疗效及其安全性比较

Clinical Efficacy and Safety of Laparoscopic Assisted Vaginal Surgery and Pure Laparoscopic Surgery in Treatment of Endometrial Cancer

目的比较腹腔镜辅助阴式手术与单纯腹腔镜手术治疗子宫内膜癌的临床疗效及其安全性。方法选择2009年2月至2011年4月本溪市中心医院妇产科收治的78例子宫内膜癌患者为研究对象,按照随机数字法分为对照组和观察组,各39例。对照组实施单纯腹腔镜手术治疗,观察组实施腹腔镜辅助阴式手术治疗。对两组患者治疗后的临床效果、远期预后及术后并发症情况进行观察。结果观察组手术时间、导管留置时间、肛门排气时间显著短于对照组[(161±9)min比(199±8)min、(3.1±2.4)d比(4.3±2.1)d、(29±7)d比(34±8)d],观察组术中出血量显著少于对照组[(201±9)m L比(235±9)m L],观察组淋巴结清除数目显著多于对照组[(39±4)个比(35±4)个],差异有统计学意义(P<0.05)。观察组术后并发症发生率为5.1%(2/39),低于对照组的25.6%(10/39),差异有统计学意义(P<0.05)。观察组术后1、2、3年累积生存率分别为92.3%、84.6%、69.2%,对照组分别为74.4%、61.5%、51.3%,术后两组累积生存率比较差异有统计学意义(P<0.001)。术后对两组患者生存质量进行评分,结果显示,观察组治疗后生理功能评分、身体疼痛评分、总体健康评分、活力评分、精神健康、社会功能、生理职能、情感职能显著高于对照组[(68±9)分比(58±8)分、(74±9)分比(56±9)分、(81±9)分比(71±8)分、(73±8)分比(61±8)分、(76±6)分比(66±5)分、(67±8)分比(58±2)分、(84±6)分比(68±5)分、(83±7)分比(72±4)分],差异有统计学意义(P<0.05)。结论子宫内膜癌患者采取腹腔镜联合阴式手术治疗,其效果及手术安全性均高于单纯腹腔镜手术,可减少手术创伤,利于患者术后恢复,也可延长患者生存时间,提高生存质量,利于患者远期预后,值得临床推广。

Objective To investigate the clinical effect and safety of laparoscopic assisted vaginal surgery and laparoscopic surgery alone the operation for endometrial cancer. Methods Total of 78 eases of endometrial cancer in Benxi Central Hospital from Feb. 2009 to Apr. 2011 were included in the study, ,and divided into a control group and an observation group according to the random number table method ,39 cases each. The control group was given laparoscopic surgery alone, and the observation group received laparoscopic assisted vaginal surgery. The clinical effect after treatment, long-term prognosis and postoperative complications of the two groups were observed. Results The operative time, indwelling catheter time, flatus time of the observation group were significantly shorter than the control group [ （161± 9 ）min vs （199±8 ）min, （ 3.1±2.4） d vs （4. 3 ± 2. 1 ） d, （29± 7 ） d vs （34± 8 ） d ], the blood loss was significantly less than the control group [ （201± 9） mL vs （235 ± 9 ） mL ] , the number of lymph node dissection of the observation group was significantly more than the control group [ （39 ±4） vs （35 ±4） ] ,the differences were statistically significant（ P 〈 0.05 ） ; complications rate of the observation group was 5. 1% （ 2/39 ）, of the control group was 25.6% （ 10/39）, the differences was statistically significant （ P 〈 0. 05 ） ; the 1 -year survival rate was 92. 3%, 2-year survival rate was 84. 6%, and 3-year survival rate was 69. 2% in the observation group and was 74.4%, 61.5%, 51.3% in the control group,and the differences were statistically significant（P 〈 0. 001 ）. The postoperative quality of life of the two groups were scored, and the results showed that the physi- ological function score, body pain score, overall health rating, vitality score, mental health, social function, physiological function, emotional function of the observation group were significantly higher than the control group [ （68 ±9） scores vs（58 ±8） scores, （74±9） scores vs （56±9） scores, （81±9） scores vs （71 ±8） scores, （73 ± 8 ） scores vs （61 ± 8） scores, （76± 6） scores vs （66 ± 5 ） scores, （67 ± 8 ） scores vs （58±2） scores, （84 ±6） scores vs （68 ±5） scores, （83 ±7） scores vs （72±4） scores] ,the differences were statistically significant （ P 〈 0. 05 ）. Conclusion The laparoscopic assisted vaginal surgery for endometrial cancer,has better effect and safety than laparoscopic surgery alone,which can reduce surgical trauma, prolongs survival time and improves quality of life, and is good for the long-term prognosis, thus is worthy of promotion in clinical.