腹腔镜阴式广泛宫颈切除术与广泛子宫切除术用于Ⅰa和Ⅰb期宫颈癌的临床对比研究

Comparation between laparoscopic vaginal radical trachelectomy and radical hysterectomy for Ⅰa and Ⅰb cervical cancer

目的研究腹腔镜阴式广泛宫颈切除术(LVRT)与广泛子宫切除术(RH)用于Ⅰa和Ⅰb期宫颈癌患者的临床效果。方法选取2017年10月至2018年10月青岛大学医学院附属医院诊治的100例Ⅰa和Ⅰb期宫颈癌患者作为研究对象。抽签随机分为观察组(n=50)和对照组(n=50)。观察组患者采取LVRT进行治疗,对照组患者采取RH进行治疗。比较两组患者围术期相关临床指标(手术时间、术中出血量、淋巴结切除数、术后体温复常时间、肛门排气时间、膀胱功能恢复时间、排便时间和住院时间等)及术后并发症发生情况,另外比较两组患者治疗前后血清糖类抗原125(CA125)、癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)及患者生命质量评分。结果观察组患者手术时间、术中出血量、淋巴结切除数、体温复常时间、肛门排气时间、膀胱功能恢复时间、排便时间以及住院时间与对照组比较,差异具有统计学意义(P<0.05)。两组患者手术前后CA125、CEA及SCC-Ag水平组间比较,差异无统计学意义(P>0.05);两组患者术后CA125、CEA及SCC-Ag水平显著低于术前,差异具有统计学意义(P<0.05)。观察组患者术后功能评分、症状评分、整体生活质量评分、单项测量项目评分显著高于术前及对照组术后,差异具有统计学意义(P<0.05)。观察组患者并发症总发生率与对照组比较,差异无统计学意义(P>0.05)。结论腹腔镜阴式广泛宫颈切除术用于Ⅰa和Ⅰb期宫颈癌患者疗效显著,且术中对患者身体损伤小,出血量少,术后恢复期短,同时还可提高患者生活质量,并发症发生率较低,值得临床推广。

Objective To compare the clinical efficacy of laparoscopic vaginal radical trachelectomy(LVRT)and radical hysterectomy(RH)forⅠa andⅠb cervical cancer.Methods 100 patients withⅠa andⅠb cervical cancer admitted to the Affiliated Hospital of Medical College of Qingdao University from October 2017 to October 2018 were selected as the research objects.They were randomly divided into observation group(n=50)and control group(n=50).The control group was treated with RH,while the observation group with LVRT.The perioperative clinical indicators(operation time,intraoperative bleeding volume,number of lymph node resection,postoperative temperature normalization,anal exhaust,bladder function recovery,defecation time,hospital stay)and complications were compared between the two groups.The levels of serum[serum carbohydrate antigen 125(CA125),carcinoembryonic antigen(CEA),squamous cell carcinoma antigen(SCC-Ag)]and the life quality scores of EORTC QLQ-C30 before and after treatment were compared between the two groups.Results The operation time,intraoperative bleeding volume,number of lymph node resection,body temperature recovery time,anal exhaust time,bladder function recovery time,defecation time and hospitalization time of the observation group were significantly different from those of the control group(P<0.05).There were no significant differences in CA125,CEA and SCC-Ag levels between the two groups before and after operation(P>0.05).The postoperative levels of CA125,CEA and SCC-Ag in the two groups were significantly lower than those before operation(P<0.05).Postoperative functional score,symptom score,overall quality of life score and single measurement item score in the observation group were significantly higher than those in the preoperative group and the control group,with statistical significance(P<0.05).The total incidence of complications in the observation group was lower than the control group,and the difference was not statistically significant(P>0.05).Conclusions LVRT forⅠa andⅠb cervical cancer has distinct clinical efficacy,less intraoperative body damage and blood loss,shorter postoperative recovery period,a lower incidence of complications,can improve the patients life quality.It is worthy of clinical promotion.