腹腔镜下淋巴结切除治疗妇科恶性肿瘤的临床分析

Clinical analysis of laparoscopic pelvic and paraaortic lymphadenectomy treated patients with gynecological malignancies

目的 探讨腹腔镜下广泛子宫切除和盆、腹腔淋巴结切除用于妇科恶性肿瘤的可行性及价值。方法 对子宫内膜癌 2 1例、子宫颈癌 3 5例患者 ,根据病变部位和淋巴结切除术适应证 ,行盆腔淋巴结切除术 ,其中对 3 0例患者行选择性腹主动脉周围淋巴结切除 ,再行腹腔镜辅助阴式广泛子宫切除术。结果 腹腔镜下手术时间平均为 3 1h ,术中出血平均 198ml,切除淋巴结数平均 16个。术后住院时间平均 9 6d。术中发生膀胱损伤 2例、静脉损伤 2例 ,1例大肠损伤术中转行开腹术。术后仅 1例于 1个月后出现双侧输尿管轻度狭窄 ,1例术后 1个月出现肿瘤穿刺孔转移 ,3例出现尿潴留 ,其余无明显并发症发生。结论 对妇科恶性肿瘤施行腹腔镜下广泛子宫切除和盆、腹腔淋巴结切除术安全可靠 ;淋巴结切除彻底 ,且手术创伤小 ,并发症少 。

Objective To investigate the possiblity and value of laparoscopic radial hysterectomy with lymphadenectomy in patients with gynecology malignancies. Methods From July 2000 through June 2002, we performed laparoscopic radial hysterectomy with lymphadenectomy on 56 patients with biopsy proven endometrial or cervical carcinoma (21 endometrial cancer and 35 cervical cancers). Pelvic, para aortic, and combinations of both pelvic and para aortic lymphadenectomies were performed depending on the primary site of the disease and indication for lymph node dissection. Results Laparoscopic procedure required an average of 3 1 h, with an average blood loss of 198 ml. The average number of nodes was 16. Patients undergoing laparoscopic assisted vaginal radical hysterectomy and lymphadenectomy alone were admitted for 9 6 days on average. There were 5 patients with intraoperative complications. Two patients were bladder injury and other two patients with venous injury. One patient was colon injury and converted to an abdominal procedure. There were no ureteral or intestinal injuries. Postoperative complications occurred in 3% of patients and only one was considered ureteral constriction 1 month after operation. There has been one patient with trocar site recurrences 4 weeks after operation. Three patients have retention of urine. Conclusions Laparoscopic assisted vaginal radical hysterectomy and lymphadenectomy was feasible and safe for treatment of cervical or endometrial cancer. Also it was a less invasive, and recovery time was reduced. This was reliable and accurate method for evaluating lymph node metastasis of cervical or endometrial carcinoma.