Ⅰ期子宫内膜癌腹腔镜手术与经腹手术的对比研究

Comparison of laparoscopic and laparotomic surgeries forⅠ-stage endometrial carcinoma

目的探讨腹腔镜手术与经腹手术在早期子宫内膜癌治疗中的有效性和安全性。方法选择上海交通大学附属第六人民医院2010年7月-2019年6月Ⅰ期子宫内膜样腺癌手术病例170例,其中腹腔镜组100例,经腹组70例。回顾分析两组患者的年龄、合并症、乳腺癌史、生育史、绝经史、腹部手术史、BMI,比较两组的手术时间、术中出血量、术后住院天数、并发症、淋巴结切除数、淋巴脉管浸润患者比例,以及术后放射治疗和化学治疗的比例、复发率。结果两组患者的合并症、乳腺癌史、经产、绝经和腹部手术史患者比例的差异均无统计学意义(P值均>0.05);经腹组患者年龄显著大于腹腔镜组(P<0.05),腹腔镜组患者BMI显著大于经腹组(P<0.05),腹腔镜组术中出血量显著少于经腹组(P<0.05);两组间手术时间、术后住院天数、淋巴结切除数目、淋巴脉管浸润患者比例、术后并发症发生率的差异均无统计学意义(P值均>0.05)。两组患者均术后随访至2019年11月,腹腔镜组随访时间范围为5~63个月,平均随访24.7个月,1例术后27个月因肿瘤复发死亡,1例术后52个月肿瘤复发于肠管和肠系膜。经腹组随访时间范围为11~78个月,平均随访37.4个月,1例术后58个月肿瘤复发于左输尿管下段。两组患者复发率和生存率的差异无统计学意义(P值均>0.05)。结论腹腔镜手术治疗早期子宫内膜癌的效果和安全性与经腹手术相当,具有腹壁创伤小、术中出血量少、术后恢复快等优点,可作为治疗Ⅰ期子宫内膜癌患者的常规术式选择,其远期疗效仍有待进一步研究确证。

Objective To compare the safety and efficacy between laparoscopic and laparotomic surgeries for early-stage endometrial carcinoma.Methods From July 2010 to June 2019,170 patients with early-stage endometrial carcinoma who underwent laparoscopic(LSC group,n=100)and laparotomic(LAP group,n=70)surgeries were selected.The age,comorbidity,breast cancer history,birth history,menopause history,abdominal surgery history and BMI of the two groups were retrospectively analyzed.The operation time,intraoperative blood loss,hospital stay,postoperative complications,the number of resected lymph nodes,lympho-vascular invasion rate,chemotherapy and/or radiotherapy and recurrence rate were recorded and compared between the two groups.Results There was no significant difference in comorbidities,breast cancer history,birth history,menopause history or abdominal operation history between the two groups(all P>0.05).Neither were the operation time,hospital stay,the number of resected lymph nodes,lympho-vascular invasion rate,or postoperative complications(all P>0.05).The patients in LAP group were older than LSC group and had lower BMI and more intraoperative blood loss than LSC group(all P<0.05).All the patients were followed up until November 2019.The mean duration of follow-up was 24.7 months(range,5-63 months)in the LSC group,and 37.4 months(range,11-78 months)in the LAP group.In the LSC group,one patient died of recurrence 27 months after surgery,and tumor recurred in the intestine and mesenteric in one patient at month 52.In the LAP group,one patient had recurrence in the left lower ureter 58 months after surgery,but there was no death.No significant difference was found in the recurrent rate and survival rate between the two groups(both P>0.05).Conclusion Compared with laparotomic surgery,laparoscopic surgery has the advantages of less intraoperative blood loss,minimal abdominal trauma and quick recovery in the treatment ofⅠ-stage endometrial carcinoma.It may be a conventional option forⅠ-stage endometrial carcinoma,but its long-term clinical outcome needs to be confirmed by further research.