腹腔镜下前哨淋巴结活检联合宫颈切除术对早期宫颈癌年轻患者的价值

The Application Value of Sentinel Lymph Node Biopsy Combined with Cervical Resection under Laparoscopic in Young Patients with Early Stage of Cervical Cancer

目的探讨腹腔镜下前哨淋巴结活检联合宫颈切除术对早期宫颈癌年轻患者的价值。方法在遵循入选标准和随机对照原则的基础上,将宫颈癌Ⅰa~Ⅱa期并进行手术治疗且年龄在35岁以下的60例患者分为对照组和观察组,每组30例。对照组给予腹腔镜下广泛子宫全切术及常规淋巴结清扫,观察组则给予腹腔镜下配合前哨淋巴结活检的广泛宫颈切除术,比较两组患者手术情况、术后并发症、累积生存率、生活质量。结果近期效果:观察组出血量、手术时间、切除淋巴结个数、术后并发症发生率均优于对照组(P<0.05);远期效果:与对照组比较,观察组宫颈粘连显著减少(P<0.05),生活质量明显提高:FACT-G生活质量评分显著增高—生理状况、社会/家庭状况、情感状况和功能状况评分均增高(P<0.05),但复发转移与1、3、5年累积生存率两组比较无明显差别(P>0.05)。结论腹腔镜下前哨淋巴活检配合广泛宫颈切除术出血量少、手术时间短、术后并发症少,不仅如此,其为患者保留了生育能力,生活质量改善明显,值得临床广泛运用与研究。

Objective To explore the application value of sentinel lymph node biopsy combined with cervical resection under laparoscopic in young patients with early stage of cervical cancer. Methods Based on the principle of random control and inclusion criteria,60 young patients under 35 years old who were diagnosed as early stage of cervical cancer were divided them into the control group and the observation group, each with 30 cases. The control group was given laparoscopic hysterectomy and conventional lymph node dissection, while the observation group was given sentinel lymph node biopsy combined with cervical resection under laparoscopic, compare surgical conditions, postoperative complications, cumulative survival rate and quality of life in the 2 groups. Results The recent surgical effect ： the amount of bleeding, the operation time, the number of lymph node resection and the postoperative complication rate in the observation group were much better than the control group （ P 〈 0.05 ） ; compared with the control group, the effect of long-term operation, the cervical adhesion in the observation group was significantly reduced （ P 〈 0.05 ）, and the quality of life was significantly improved, the FACT-G quality of life score in the observation group was significantly improved, the scores of physiological status, social / family status, emotion status and function were increased （ P 〈 0.05 ） , but the patients with recurrence / metastasis and 1 - ,3- ,5-year survival rates were not significantly different （ P 〉 0.05 ）. Conclusion Laparoscopic sentinel lymph node biopsy with extensive cervical resection can reduce the amount of bleeding, shorten operation time and reduce postoperative complications, moreover, it retained the fertility for patients to improve the life quality, in a word,it is worthy to be widely used in clinical practice and research.