改良腹腔镜子宫广泛性切除术治疗ⅠA2~ⅠB1期子宫颈癌的临床分析

Clinical analysis of modified laparoscopic extensive hysterectomy in the treatment of stageⅠA2-ⅠB1 cervical cancer

目的比较ⅠA2~ⅠB1期子宫颈癌患者行改良腹腔镜与完全腹腔镜子宫广泛性切除术的围手术期情况。方法收集2017年2月—2020年6月蚌埠医学院第一附属医院妇瘤科收治的按国际妇产科联盟(FIGO)临床分期为ⅠA2~ⅠB1期并接受腹腔镜子宫广泛性切除术的子宫颈癌患者。回顾性分析其临床病理、手术情况和术后恢复情况。共30例患者纳入本研究,其中改良腹腔镜(免举宫杯及阴道封闭切取样本)与完全腹腔镜(有举宫杯)子宫广泛性切除术各15例。比较2组患者手术时间、出血量、切除宫旁长度、切除阴道壁长度、围手术期并发症及术后恢复情况等。结果2组患者年龄[(50.13±7.35)岁vs.(44.80±7.46)岁]、BMI(24.26±3.57 vs.23.48±3.01)、FIGO分期(ⅠA2/ⅠB1:4/11 vs.1/14)以及病理类型(鳞癌/腺癌:13/2 vs.10/5)比较,差异均无统计学意义(均P>0.05)。2组患者的手术时间[223(204,248)min vs.100(80,300)min]、术中出血量[216(179,251)mL vs.100(76,300)mL]、切除阴道壁长度[(3.32±0.20)cm vs.(3.49±0.29)cm]以及宫旁长度[(3.25±0.27)cm vs.(3.41±0.32)cm]比较,差异均无统计学意义(均P>0.05)。2组患者尿潴留(有/无:4/11 vs.2/13)、深静脉血栓(有/无:3/12 vs.1/14)、淋巴囊肿(有/无:6/9 vs.8/7)、是否术后补充治疗(是/否:8/7 vs.8/7)、术后排气时间[(2.80±0.41)d vs.(2.79±0.43)d]和术后住院时间[(5.13±1.64)d vs.(5.60±0.99)d]比较,差异均无统计学意义(均P>0.05)。结论改良腹腔镜子宫广泛性切除术与完全腹腔镜子宫广泛性切除术相比有着相同的安全性,值得进一步推广应用。

Objective To compare the perioperative conditions of modified laparoscopic and complete laparoscopic extensive hysterectomy in patients with stageⅠA2-ⅠB1 cervical cancer.Methods Patients who were admitted at the Department of Gynecology and Oncology of the First Affiliated Hospital of Bengbu Medical College from February 2017 to June 2020 were recruited.The patients were graded as clinical stageⅠA2-ⅠB1 according to the International Federation of Gynecology and Obstetrics(FIGO)and received laparoscopic extensive hysterectomy for cervical cancer.The clinical pathology,surgery and postoperative recovery of patients were retrospectively analysed.A total of 30 patients were included in this study,including 15 cases of modified laparoscopic(no lifting cup and closed vaginal resection sample)and complete laparoscopic(with lifting cup)extensive hysterectomy.The operation time,blood loss,length of parauterine resection,length of vaginal wall resection,perioperative complications and postoperative recovery were compared between the two groups.Results No statistically significant differences were observed in the age[(50.13±7.35)years vs.(44.80±7.46)years],body mass index(24.26±3.57 vs.23.48±3.01),FIGO staging(ⅠA2/ⅠB1:4/11 vs.1/14)and pathological type(squamous carcinoma/adenocarcinoma:13/2 vs.10/5)of the two groups of patients(all P>0.05).Moreover,no statistically significant differences were observed in the operation time[223(204,248)min vs.100(80,300)min],intraoperative blood loss[216(179,251)mL vs.100(76,300)mL],length of vaginal wall resected[(3.32±0.20)cm vs.(3.49±0.29)cm]and length of parauterine wall[(3.25±0.27)cm vs.(3.41±0.32)cm]between the two groups(all P>0.05).In addition,no significant differences were observed in urinary retention(yes/no:4/11 vs.2/13),deep vein thrombosis(yes/no:3/12 vs.1/14),lymphatic cyst(yes/no:6/9 vs.8/7),postoperative supplementary treatment(yes/no:8/7 vs.8/7),postoperative exhaust time[(2.80±0.41)d vs.(2.79±0.43)d]and postoperative hospital stay[(5.13±1.64)d vs.(5.60±0.99)d]between the two groups of patients(all P>0.05).Conclusion Modified laparoscopic extensive hysterectomy has the same safety as complete laparoscopic hysterectomy and is worthy of further promotion.