子宫内膜癌腹腔镜下广泛子宫切除联合盆腔及腹主动脉旁淋巴结清扫术治疗的临床效果

Clinical Effect of Laparoscopic Extensive Hysterectomy Combined with Pelvic and Para-aortic Lymph Node Dissection in the Treatment of Endometrial Carcinoma

目的探讨腹腔镜下广泛子宫切除联合盆腔及腹主动脉旁淋巴结清扫术治疗子宫内膜癌的临床效果。方法 2015年1月至2017年6月期间我院收治的50例子宫内膜癌患者,随机分为两组,每组各25例,对照组施行开腹手术,观察组施行腹腔镜下广泛子宫切除联合盆腔及腹主动脉旁淋巴结清扫术,比较两组患者的手术时间、术中出血量、淋巴结清扫情况、术后恢复时间、并发症发生率、免疫功能指标、术后疼痛评分。结果两组患者的手术时间、淋巴结清扫数量比较无统计学意义(P>0. 05),但观察组的术中出血量明显少于对照组(P<0. 05)。相比于对照组,观察组的术后排气时间、盆腔引流时间、住院时间均显著缩短(P<0. 05)。观察组的并发症总发生率为4%,对照组为18%,组间比较有统计学意义(P<0. 05)。对照组治疗后的各项免疫功能指标均较治疗前显著降低(P<0. 05),而观察组治疗前后各项免疫功能指标比较均无统计学意义(P>0. 05)。术后8h、12h、24h、48h,观察组的疼痛评分均低于对照组(P<0. 05)。结论在子宫内膜癌患者中,采取腹腔镜下广泛子宫切除联合盆腔及腹主动脉旁淋巴结清扫术治疗,可有效清扫淋巴结,还可减轻手术创伤。

Objective To study the clinical effect of laparoscopic extensive hysterectomy combined with pelvic and para-aortic lymph node dissection in the treatment of endometrial carcinoma.Methods From January 2015 to June 2017,50 patients with endometrial carcinoma treated in our hospital were randomly divided into two groups,25 cases in each group.The control group was given open surgery,while the observation group received laparoscopic extensive hysterectomy combined with pelvic and para-aortic lymph node dissection.The operative time,amount of intraoperative bleeding,lymph node dissection,postoperative recovery time,incidence of complications,immune function indexes and postoperative pain score were compared between the two groups.Results There was no significant difference in the operative time and the number of lymph node dissection between the two groups（ P〈0.05）,but the amount of intraoperative bleeding in the observation group was significantly less than that in the control group（ P〈0.05）.Compared with the control group,the postoperative exhaust time,pelvic drainage time and hospitalization time were significantly shortened in the observation group（ P〈0.05）.The total incidence of complications was 4% in the observation group and18% in the control group,and there was significant difference between the two groups（ P〈0.05）.After treatment,the immune function indexes of the control group were significantly lower than those before treatment（ P〈0.05）,but in the observation group,no significant difference before and after treatment（ P〉0.05）.8 h,12 h,24 h and 48 h after operation,the pain scores in the observation group were all lower than those in the control group（ P〈0.05）.Conclusion In patients with endometrial carcinoma,laparoscopic extensive hysterectomy combined with pelvic and para-aortic lymph node dissection can effectively dissect lymph nodes and reduce surgical trauma.