宫颈癌腹腔镜手术改良方向及相关措施进展

Advances in the Improving Direction of Laparoscopic Surgery for Cervical Cancer

宫颈癌(cervical cancer,CA)是女性常见恶性肿瘤之一。随着微创理念的深入及技术的发展,腹腔镜已成为宫颈癌手术治疗的一种方式,具有减少术中出血量、降低伤口感染率、缩短住院时间,且不增加术后并发症等优点。然而,最新的临床实验研究指出,腹腔镜根治性子宫切除术(laparoscopic radical hysterectomy,LRH)与传统开腹手术相比,存活率低、复发率高。导致腹腔镜手术预后不良的原因可能与术中举宫器、CO2气腹的使用及阴道断端的处理有关。针对目前微创手术遇到的瓶颈问题,本文对上述原因进行阐述,并对手术步骤及器械改良方法进行总结。有助于加强临床医生对于腹腔镜手术的理解,为腹腔镜手术改良提供方向。

Cervical cancer(CA)is one of common malignant tumors in women.With the development of minimally invasive concept and technology,laparoscopy has become a conventional method of cervical cancer surgery,which has the advantages of reducing intraoperative blood loss,decreasing wound infection rate,shortening hospital stay,and not increasing postoperative complications.However,the latest clinical experimental studies point out that laparoscopic radical hysterectomy(LRH)has low survival rate and high recurrence rate compared with traditional open surgery.The reasons leading to the poor prognosis of laparoscopic surgery may be related to the use of intraoperative uterine manipulator,CO2 pneumoperitoneum and the treatment of vaginal cuff.In view of the bottleneck problems encountered in the current minimally invasive surgery,this article explains the mechanism of the low survival rate and high recurrence rate of cervical cancer after laparoscopic surgery caused by the above reasons,and summarizes the surgical procedures and improved methods of equipment.It is helpful to strengthen the understanding of laparoscopic surgery of clinicians and provide directions for laparoscopic improvement.