腹腔镜与开腹手术治疗子宫内膜癌的近期效果及安全性研究

Short-term Effect and Safety of Laparoscopic Surgery and Traditional Open Surgery in the Treatment of Endometrial Cancer

目的对比观察腹腔镜和传统开腹手术治疗子宫内膜癌的近期效果及安全性。方法选取2016年4月-2017年9月我院手术治疗的79例子宫内膜癌患者,根据手术方式的不同分为观察组41例和对照组38例,对照组予传统开腹手术治疗,观察组予腹腔镜子宫内膜癌根治术。比较两组手术相关指标;两组术后1 d疼痛视觉模拟评分(visual analogue scale, VAS)及术后6个月简明健康状况调查量表(short from 36 health survey questionnaire, SF-36)评分;术后随访半年,记录两组术后并发症发生情况;随访2年,比较两组中位生存时间及生存率。结果两组手术时间、淋巴结清扫个数比较差异均无统计学意义(P>0.05);观察组术中出血量少于对照组,术后肛门排气时间、术后自主下床活动时间及术后住院时间均短于对照组(P<0.05或P<0.01)。术后1 d VAS评分观察组低于对照组,术后6个月SF-36评分观察组高于对照组,差异有统计学意义(P<0.05)。术后随访半年,观察组术后并发症总发生率为14.63%低于对照组的36.84%(χ2=5.144,P=0.023)。术后随访2年,两组中位生存时间及生存率比较差异均无统计学意义(P>0.05)。结论腹腔镜手术和传统开腹手术治疗子宫内膜癌在手术时间、淋巴结清扫效果、短期中位生存时间及生存率方面效果相当,但腹腔镜手术治疗可明显减少术中出血量,促进术后肠功能恢复,减轻术后疼痛,缩短住院时间,提高患者术后生活质量,降低术后并发症发生率。

Objective To compare the short-term effect and safety of laparoscopic surgery and traditional open surgery in the treatment of endometrial cancer. Methods From April 2016 to September 2017, 79 patients with endometrial cancer who underwent operation in our hospital were divided into observation group(n=41) and control group(n=38) according to different surgical methods. The control group was treated with traditional open surgery, and the observation group was treated with laparoscopic radical surgery for endometrial cancer. The operation related indexes were compared between the two groups. The pain visual analogue scale(VAS) score and the MOS 36-item short-form health survey(SF-36) were assessed in the two groups at the first day after operation. At 6-month follow-up after surgery, and the postoperative complications of the two groups were recorded. At 2-year follow-up, median survival time and survival rate between the two groups were compared. Results there was no significant difference between the two groups in the duration of operation and the number of lymph node dissected(P>0.05). The amount of bleeding in the observation group was less than that in the control group, the time of anal exhaust after operation, the time of autonomous getting out of bed after operation and the duration of hospitalization after operation were shorter than those in the control group(P<0.05 or P<0.01). The VAS score of the observation group was lower than that of the control group at 1 day after operation, and the SF-36 score of the observation group was higher than that of the control group at 6 months after operation(P<0.05). At 6-month follow-up, the total incidence of postoperative complications in the observation group was 14.63%, which was lower than 36.84% in the control group(χ~2=5.144, P=0.023). At 2-year follow-up, there was no significant difference in median survival time and survival rate between the two groups(P>0.05). Conclusion Laparoscopic surgery has the same effect as traditional open surgery on endometrial cancer in terms of duration of operation, effect of lymph node dissection, short-term median survival time and survival rate. However, laparoscopic surgery can significantly reduce the amount of intraoperative bleeding, promote the recovery of postoperative intestinal function, reduce postoperative pain, shorten length of hospital stay, improve postoperative quality of life, and reduce the incidence of postoperative complications.