腹腔镜和开腹手术在卵巢癌二次探查术中的应用效果比较

Comparison of Laparoscopy and Laparotomy in Second Look Laparotomy of Ovarian Cancer

目的:比较腹腔镜和开腹手术在卵巢癌二次探查术中的应用效果和安全性。方法:选择2012年1月至2015年10月于我院就诊的卵巢癌患者58例,根据二次探查术的方式分成两组,腹腔镜组(28例)和开腹手术组(30例),观察比较两组患者手术时间、术中出血量、肛门首次排气时间、并发症发生率及二次探查的阳性率。对两组患者进行随访,比较两组患者二探术后的复发率及生存时间。结果:腹腔镜组肛门首次排气时间明显短于开腹组患者,术中出血量也均明显少于开腹组患者,具有非常显著性差异(P<0.05),而两组的手术时间、并发症发生率和二探阳性率相近,两组之间比较,差异无统计学意义(P>0.05)。二次探查术阳性和二次探查术阴性的患者中,腹腔镜组和开腹组的中位生存时间比较,差异无显著性(P>0.05)。二次探查术阴性的患者中,腹腔镜组和开腹组患者随访期间的复发率比较,差异也无显著性(P>0.05)。结论:腹腔镜二次探查术具有创伤小、并发症少、患者恢复快、患者易于接受等微创优势,且能取得与开腹二次探查术相当的安全性和准确性,可以作为卵巢癌二次探查术的手段之一。

Objective： To investigate and compare the application effect and safety of laparoscopy and laparotomy in second look laparotomy of ovarian cancer. Methods： 58 patients with ovarian cancer admitted to our hospital from Jan 2012 to Oct 2015 were chosen and divided into laparoscopy group（n=28） and laparotomy group（n=30） based on different methods of second look laparotomy. The operation time, intraoperative blood loss, first anal exhaust time, complication occurrence rate and positive rate of two groups were observed and compared. The post-operative recurrence rate and survival time of two groups were compared during follow-up. Results：The first anal exhaust time of laparoscopy group was obviously shorter than that of laparotomy group, and the intraoperative blood loss clearly less than the latter group, and the differences were statistically significant（P〈0.05）. The operation time, complication occurrence rate and positive rate of two groups were similar and the differences were not statistically significant（P〉0.05）. Among the patients who were positive and negative in second look laparotomy, no statistical difference existed among the two groups in median survival time（P〉0.05）. Among patients who were negative, the recurrence rate of two groups were also similar and the difference was not significant（P〉 0.05）. Conclusion： Laparoscopic second look laparotomy has advantages of minor trauma, less complication, quick recovery and easy for patients to accept. Moreover, it can achieve comparable safety and accuracy of second look laparotomy. Therefore, it can be used as one of the means of second look laparotomy of ovarian cancer.