手助腹腔镜与开腹卵巢癌肿瘤细胞减灭术的比较研究

Comparative study of hand-assisted laparoscopic surgery and open abdomen cytoreductive surgery of ovarian malignant tumor

目的本研究探讨一种"杂交"的手术方式——手助腹腔镜手术(hand-assisted laparoscopic surgery,HALS)在卵巢癌肿瘤细胞减灭术中的应用;并将其与常规开腹手术(open surgery,OS)进行初步的临床对比研究,为卵巢癌的临床治疗提供新思路。方法收集自2014年11月至2016年11月因卵巢癌行肿瘤细胞减灭术的58例患者,其中手助腹腔镜组(HALS组)18例、开腹组(OS组)40例。HALS组与OS组患者的年龄[(58.33±8.19)岁VS(55.95±7.29)岁,P>0.05],2组患者合并症分别包括高血压、糖尿病、肥胖、低蛋白血症、盆腹腔手术史等,一般情况比较差异无统计学意义(P>0.05),具有可比性。观察指标:手术切口长度、手术时间、术中出血量、术后残留肿瘤大小、术后肠道恢复时间、术后住院时间、术后第一次化疗的时间之间的差异,2组患者术后肿瘤分期的分布,及生存期情况之间的差异。结果 HALS组与OS组组间手术及术后指标相比:手术切口长度[(7.22±0.42)cm vs(22.73±1.54)cm]、术中出血量[(569.44±249.79)ml vs(881.50±539.73)ml]、术后肠道功能恢复时间[(2.89±0.90)d vs(3.95±0.88)d]、术后第一次化疗时间[(11.07±3.26)d vs(13.54±3.06)d],HALS组均少于OS组,差异有统计学意义(P<0.05)。手术时间[(263.61±70.86)min vs(275.00±29.96)min]、术后住院天数[(18.17±5.35)d vs(18.20±3.93)d],HALS组与OS组差异无统计学意义(P>0.05)。术后残留肿瘤直径<1 cm的患者HALS组占总数88.89%,而OS组占总数62.5%。自2014年11月随访患者至2016年11月,HALS组与OS组患者的术后短期生存率差异无统计学意义(P>0.05)。结论与开腹卵巢癌肿瘤细胞减灭术相比,手助腹腔镜手术没有降低治疗效果,并且具有安全可行、创伤小、恢复快、肿瘤细胞减灭程度满意的优势,值得在临床中推广应用。早期卵巢癌可在腹腔镜下行肿瘤细胞减灭术;大部分晚期卵巢癌可借助手助腹腔镜技术完成满意的肿瘤细胞减灭术,小部分可先进行新辅助化疗再行肿瘤细胞减灭术;术后结合敏感化疗药物的应用,改善患者的预后。

Objective To investigate the clinical therapeutic effects of hand-assisted laparoscopic surgery（ HALS） in cytoreductive surgery of ovarian malignant tumor,and to compare the tharepeutic effects between HALS and open abdomen surgery（ OS） in treatment of advanced ovarian cancer in order to provide an new way to treat ovarian cancer in clinical practice. Methods A total of 58 patients with ovarian malignant tumor who were treated by tumor cytoreductive surgery in our hospital from November 2014 to November 2016 were randomly divided into HALS group（ n = 18） and OS group（ n = 40）.There were no significant differences in general data and complications including patient＇s age,disease history of hypertension,diabetes,obesity,hypoproteinemia,operation history of abdominopelvic cavity between the two groups（ P〈0. 05）. The length of operational cut,operation duration,intraoperative blood loss,the size of residual tumor after operation,gastrointestinal recovery time after operation,the postoperative hospitalization time,the first chemotherapy time,the postoperative pathological stage and the survival time were observed and comapred between two grousp. Results As compared with OS group,the HALS group had significantly shorter length of operative incision [（ 7. 22 ± 0. 42） cm vs（ 22. 73 ± 1. 54） cm,P〈0. 05 ],less intraoperative blood loss [（ 569. 44 ± 249. 79） ml vs（ 881. 50 ± 539. 73） ml,P〈0. 05],shorter gastrointestinal recovery time[（ 2. 89 ±0. 90） d vs（ 3. 95 ±0. 88） d,P〈0. 05],shorter first chemotherapy time afer operation [（ 11. 07 ±3. 26） d vs（ 13. 54 ±3. 06） d,P〈0. 05],however,there were no significant differences between two groups in hospitalization time [（ 18. 17 ±5. 3 5） d vs（ 1 8. 2 0 ± 3. 9 3） d,P〈0. 0 5] and operative time [（ 263. 61 ± 70. 86） min vs（ 275. 00 ±29. 96） min,P〈0. 05]. Moreover of the satisfaction degree in HALS group was higher than that in OS group（ P〈0. 05）. Moreover there was not significant difference in short-term survival rate after operation of patients between two groups（ P〈0. 05）. Conclusion As compared with open abdomen surgery,HALS has the advantages including safety,feasibility,mini-invasion,quicker recovery,optimal cytoreductive surgery,therefor,which is worthy of application and promotion in clinical practice.