腹腔镜治疗肥胖型子宫内膜癌患者的临床疗效观察

Observation of the clinical effects of laparoscopic surgery for obese patients with endometrial cancer

目的探讨腹腔镜手术治疗肥胖型子宫内膜癌患者的临床效果。方法回顾性分析63例早期肥胖型子宫内膜癌患者（BMI≥30kg／m2）临床资料。按NCCN治疗指南实施包括盆腔、腹主动脉旁淋巴结清扫在内的子宫内膜癌根治术，其中腹腔镜下完成40例，开腹完成23例。比较2组术中出血量、淋巴结切除数量、术中及术后并发症等。结果腹腔镜组术中出血量[（65．3±11．8）m1]与开腹组术中出血量[（165．6±58．3）ml]相比，差异有统计学意义（P〈0．01）；2组淋巴结清扫总数目差异无统计学意义（P〉0．05）；腹腔镜组术后肛门排气时间及术后平均住院时间均短于开腹组，差异有统计学意义（P〈0．01）；2组在术中膀胱损伤、尿道损伤、肠壁损伤发生率上差异无统计学意义（P〉0．05）；而开腹组有5例出现切口脂肪液化及4例深静脉血栓形成，腹腔镜组无切口脂肪液化及深静脉血栓形成，2组比较差异有统计学意义（P〈0．01）。结论与开腹手术治疗早期肥胖型子宫内膜患者相比，腹腔镜手术具有术中出血少、术后恢复快、并发症少等优点，是一种安全、有效的手术方式。

Objective To explore the therapeutic effects of laparoscopic surgery for obese patients with endometrial cancer. Methods Clinical data were collected from 63 obese patients with early - stage endometrial cancer （ BMI≥30 kg/m2 ） and analyzed retrospectively. According to the guidelines of the National Comprehensive Cancer Network （ NC- CN）, radical surgery of endometrial cancer was carried out including pelvic and para -aortic lymphadenoectomy, in which laparoscopic surgery was provided for 40 patients and laparotomy for 23 patients. Then, both groups were compared for the blood volume, the amount of lymph nodes dissected and the complications during and after operation were com- pared. Results The average blood loss was （65.3 ± 11.8） ml in the laparoscopic group, which was significantly less than that of the laparotomy group （165.6 ±58.3） ml （P 〈 0.01 ）. The number of the lymph nodes dissected in the lapa- roscopic group was （36 ± 6）, which was not remarkably different from that of the laparotomy group （ 32 ± 4） （ P 〉0. 05）. The laparoscopic group showed markedly shorter anus exhaust time and the average duration of hospitalization than the laparotomy group （ P 〈 0. 01 ）. No statistical difference was found as to the incidences of bladder injury, urethral injury and intestinal wall injury between both groups （P 〉 0.05）. There were five cases of incision fat liquefaction and 4 cases of deep vein thrombosis in the laparotomy group, which was statistical different from the laparoscopic group where neither incision fat liquefaction nor deep vein thrombosis was reported （P 〈 0.01 ）. Conclusion Laparoscopic surgery has the advantages of less intraoperative bleed loss, faster postoperative recovery and fewer complications compared with laparotomy surgery and it is a safe, feasible surgical technique for obese patients with early - stage endometrial cancer.