25例早期宫颈癌无瘤化免举宫腹腔镜子宫切除术临床效果

Clinical efficacy of laparoscopic radical hysterectomy without lift and tumor spillage in 25 cases of early-stage cervical cancer

目的探讨早期宫颈癌无瘤化免举宫腹腔镜子宫切除手术方式的可行性及临床效果。方法选择2020年3月至2021年1月于山东大学第二医院接受无瘤化免举宫腹腔镜子宫切除术的25例早期宫颈癌患者为研究对象。术中通过经阴道封闭瘤体、淋巴结清扫后立即装袋隔离、牵拉缝线代替举宫器、阴道末端环扎及闭合、子宫切除后立即装袋隔离,确保手术的免举宫及无瘤化原则。结果25例早期宫颈癌患者均顺利完成无瘤化免举宫腹腔镜子宫切除术,无中转开腹及输尿管、肠管损伤。平均手术时间(205.3±18.7)min,平均术中出血量(79.28±20.16)mL。左、右侧宫旁组织切除宽度分别为(2.8±0.6)cm、(2.9±0.4)cm,主韧带切除长度(2.9±0.35)cm,宫骶韧带切除长度(3.18±0.36)cm,阴道切除长度(3.2±0.21)cm。盆腔淋巴结清扫数目(22.5±4.3)枚。术后病理结果显示均无淋巴结转移,宫旁切缘及阴道切缘均为阴性。术后平均排气时间(34.18±8.67)h,术后拔出尿管时间(11.05±3.67)d。结论该手术方式安全可行,既保证了足够的手术切除范围,又最大程度上确保了手术过程中的无瘤化原则。

Objective To explore the feasibility and clinical efficacy of laparoscopic hysterectomy without lift and tumor spillage for cervical cancer at early stage.Methods A total of 25 patients with cervical cancer who received laparoscopic hysterectomy without lift and tumor spillage at The Second Hospital of Shandong University during Mar.2020 and Jan.2021 were enrolled.During the surgery,the neoplasia was sealed via the vagina.The lymph nodes were bagged immediately after dissection,sutures were pulled to lift the uterus,the vaginal end was ligated and occluded,and the uterus was bagged immediately after hysterectomy to ensure no tumor spillage.Results All 25 patients successfully completed laparoscopic hysterectomy without conversion to open surgery,and there were no ureteral or intestinal injuries.The average operation time was(205.3±18.7)min,and average intraoperative bleeding volume was(79.28±20.16)mL.The widths of the excised left and right parauterine tissues were(2.8±0.6)cm and(2.9±0.4)cm,respectively.The lengths of excised main ligament,uterosacral ligament and vagina were(2.9±0.35)cm,(3.18±0.36)cm,and(3.2±0.21)cm,respectively.The number of dissected pelvic lymph nodes was(22.5±4.3).No lymph node metastasis was observed.The margins of hysterectomy and vaginectomy were negative.The mean time of postoperative ventilation was(34.18±8.67)h,and the catheter removal time was(11.05±3.67)d.Conclusion This surgical approach is safe and feasible,which ensures not only enough resection range,but also no tumor spillage during operation.