腹腔镜手术在子宫内膜癌患者中的应用效果

Application effect of laparoscopic surgery in patients with endometrial cancer

目的探讨腹腔镜手术在子宫内膜癌患者中的应用效果。方法根据手术方式的不同将60例子宫内膜癌患者分为对照组(n=30)和观察组(n=30),对照组患者采用开腹手术治疗,观察组患者采用腹腔镜手术治疗。比较两组患者的围手术期指标、排尿功能、免疫功能、血清肿瘤标志物[人附睾蛋白4(HE4)、糖类抗原125(CA125)]水平、并发症发生情况、局部复发和远处转移情况。结果观察组患者的术中出血量明显少于对照组,肛门排气时间、尿管留置时间、住院时间均明显短于对照组,差异均有统计学意义(P<0.01);两组患者的淋巴结清扫数目比较,差异无统计学意义(P>0.05)。观察组患者获得膀胱充盈感时间、残余尿量≤100 ml时间均明显短于对照组(P<0.01)。术后3天,两组患者的血清CA125、HE4水平均低于本组术前,且观察组患者的血清CA125、HE4水平均低于对照组,差异均有统计学意义(P<0.05)。术后3天,两组患者的CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)均低于本组术前,观察组患者的CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)均高于对照组,差异均有统计学意义(P<0.05)。观察组患者的并发症总发生率低于对照组(P<0.05)。随访5年,两组患者的局部复发率和远处转移率比较,差异均无统计学意义(P﹥0.05)。结论腹腔镜手术治疗子宫内膜癌可缩短患者的住院时间,促进患者排尿功能的恢复,对机体免疫功能的影响小,还可降低患者术后并发症发生率,且与开腹手术具有相同的远期疗效。

Objective To investigate the effect of laparoscopic surgery in patients with endometrial cancer.Method A total of 60 patients with endometrial cancer were divided into control group(n=30)and observation group(n=30)according to different surgical methods.Patients in the control group were treated with laparotomy,and patients in the observation group were treated with laparoscopic surgery.The perioperative indicators,voiding function,immune function,serum tumor markers[human epididymis protein 4(HE4),carbohydrate antigen 125(CA125)]levels,complications,local recurrence and distant recurrence were compared between the two groups.Result The intraoperative blood loss in the observation group was significantly less than that in the control group,and the anal exhaust time,urinary catheter indwelling time,and hospital stay were significantly shorter than those in the control group,and the differences were statistically significant(P<0.01).There was no significant difference in the number of dissected lymph nodes between the two groups(P>0.05).The time to obtain bladder fullness and residual urine volume≤100 ml in the observation group were significantly shorter than those in the control group(P<0.01).Three days after the operation,the serum CA125 and HE4 levels of the two groups were lower than those before the operation,and the serum CA125 and HE4 levels of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).Three days after the operation,the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the two groups were lower than those before the operation,and the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The total incidence of complications in the observation group was lower than that in the control group(P<0.05).During the 5-year follow-up,there were no significant differences in the local recurrence rate and distant metastasis rate between the two groups(P>0.05).Conclusion Laparoscopic surgery for endometrial cancer could shorten the hospital stay of patients and promote the recovery of urinary function.This operation has little impact on the immune function of the patient,and could also reduce the incidence of postoperative complications with the comparable long-term efficacy as laparotomy.