腹腔镜与开腹手术治疗早期子宫内膜癌效果及预后影响因素分析

Comparison of laparoscopy and laparotomy in treatment of endometrial carcinoma and influence fators of prognostic

目的:探究应用腹腔镜手术或开腹手术治疗子宫内膜癌的临床疗效以及预后影响因素。方法:2016年1月-2020年7月从本院诊治的子宫内膜癌患者中抽取80例随机分为微创组、开腹组各40例,分别实施腹腔镜手术或开腹手术治疗,随访术后1年,复发及死亡为不良预后,对比两组临床疗效并分析预后影响因素。结果:开腹组手术时间(78.6±12.9min)、出血量(178.5±32.4ml)、留置导尿管时间(5.3±1.3d)、住院时间(7.5±1.3d)均高于微创组(121.8±17.5 min、278.4±62.5 ml、12.3±3.2 d、18.3±2.4 d),两组术后排尿功能指标均较术前降低,但微创组排尿功能指标高于开腹组,膀胱功能指标低于开腹组(均P<0.05);两组术后性功能评分相较术前降低,但微创组高于开腹组(P<0.05);并发症发生率腹腔镜组(7.5%)低于开腹组(25.0%)(P<0.05)。患者年龄≥60岁、病理分期Ⅰb期、开腹手术是影响预后的独立危险因素,腹腔镜微创手术为预后保护因素。结论:应用微创腹腔镜手术可降低手术对患者排尿功能、膀胱功能、性功能的不利影响,具有手术时间短、创伤小、并发症风险低等优势;老年、临床分期Ⅰb期、开腹手术者预后不良风险增加,提示临床应重点术后护理。

Objective:To explore the clinical efficacy and prognostic factors of minimally invasive laparoscopic surgery and laparotomy in patients with endometrial cancer.Methods Eighty patients with endometrial cancer admitted in our hospital from January 2016 to July 2020 were selected for the study,and randomly divided into minimally invasive group and open group,40 cases in each group.Minimally invasive laparoscopic surgery and open surgery were performed respectively.The clinical efficacy of the two groups were compared and the influencing factors of patients'prognosis were further analyzed.Results:The operative time,blood loss,indwelling catheter time and hospital stay in the open group significantly increased than those in the minimally invasive group(P<0.05);The postoperative urination function indexes in both groups significantly decreased than those before surgery,the urinary function indexes in the minimally invasive group significantly increased than those in the open group,and the bladder function indexes in the minimally invasive group significantly decreased than those in the open group(P<0.05);The postoperative sexual function score of the two groups significantly decreased than that of the preoperative group,and the postoperative sexual function score of the minimally invasive group significantly increased than that of the open group(P<0.05);The proportion of complications in minimally invasive group and open group was 7.5%and 25.0%respectively(P<0.05);The proportion of patients with endometrial carcinoma aged≥60 years,pathological stageⅠb and open operation with poor prognosis significantly increased(P<0.05;Age≥60 years,pathological stageⅠb period,laparotomy were independent risk factors for prognosis of patients with endometrial cancer,while laparoscopic minimally invasive surgery was a protective factor for prognosis.Conclusions Endometrial cancer patients with application of minimally invasive laparoscopic surgery can reduce the micturition function,bladder function,sexual function of patients with adverse effect,at the same time,this scheme has shorter operation time,less trauma,lower risk of complications,Elderly patients with endometrial cancer,clinical stageⅠb and open operation have a higher risk of poor prognosis,These patients should receive intensive postoperative care,so minimally invasive surgery is a feasible option to reduce the risk of poor prognosis.