腹腔镜与开腹手术治疗子宫内膜癌的临床对照研究

Clinical Control Study of Laparoscopic and Laparotomy Surgery for Endometrial Cancer

目的探讨腹腔镜手术与开腹手术治疗子宫内膜癌的疗效。方法选取65例子宫内膜癌患者,入院后随机分为两组,开腹组(33例)采用开腹手术治疗,腹腔镜组(32例)采用腹腔镜手术治疗,根据手术指标、术前术后血清Hs-CRP水平及随访1个月期间并发症发生情况,评价腹腔镜手术与开腹手术治疗子宫内膜癌的疗效。结果腹腔镜组患者术后留置引流管时间、术后住院时间、抗生素使用时间均短于开腹组患者(P<0.05),腹腔镜组术中出血量也要少于开腹组患者(P<0.05),但两种手术方法清扫淋巴结数目相比,无统计学差异(P>0.05),腹腔镜组手术时间长于开腹组(P<0.05);术前两组Hs-CRP水平相比,无统计学差异(P>0.05),术后24h,两组血清Hs-CRP水平明显下降(P<0.05),但两组血清Hs-CRP水平相比,无统计学差异(P>0.05),腹腔镜并发症的总发生率低于对照组(P<0.05)。结论腹腔镜手术对子宫内膜癌手术创伤小,患者恢复快,与开腹手术具有相当淋巴结清扫能力,手术完成后能显著降低患者体内Hs-CRP水平,预后良好,是治疗早期子宫内膜癌的理想手术方式。

Objective To investigate the curative effect of laparoscopic surgery and laparotomy for patients with endometrial carcinoma. Methods 65 patients with endometrial cancer were randomly divided into 2 groups,laparotomy group（ 33 cases） was treated by laparotomy,and laparoscopic group（ 32 cases） treated by laparoscopy surgery. The operation indexes,HsCRP level in serum before and after surgery,complications during the 1 month follow-up of the 2 groups were analyzed,to estimate the curative effect of laparoscopic surgery and laparotomy on endometrial carcinoma. Results In laparoscopic group,after surgery the drainage tube indwelling time and hospital stay,and the time of using antibiotics were shorter than the laparotomy group（ P〈0. 05）,the amount of bleeding in the laparoscopic group was less than the control group during the operation（ P〈0. 05）. But there was no significant difference between the 2 kinds of operation methods on cleaning lymph nodes（ P〈0. 05）,the operative time of laparoscopic group was longer than laparotomy group（ P〈0. 05）. There had no statistical difference in Hs-CRP levels（ P〈0. 05）. After 24 h operation,the serum level of Hs-CRP of the 2 groups decreased significantly（ P〈0. 05）,but the serum level of Hs-CRP between the 2 groups had no significant difference（ P〈0. 05）. The total incidence of complications in laparoscopic group was lower than laparotomy group（ P〈0. 05）. Conclusion Laparoscopic surgery for endometrial cancer has smaller surgical trauma,the time of recovery is shorter,the ability of cleaning lymph nodes is similar with laparotomy. After surgery the level of Hs-CRP significantly reduced and patients have good prognosis. Laparoscopic surgery is an ideal surgical treatment for early endometrial cancer.