肾血管水平腹主动脉旁淋巴结+骶前淋巴结清扫在子宫内膜癌腹腔镜手术中的应用效果

Application effect of renal vascular level abdominal paraaortic lymph node combined with presacral lymph node dissection in laparoscopic surgery for endometrial carcinoma

目的研究肾血管水平腹主动脉旁淋巴结+骶前淋巴结清扫在子宫内膜癌(EC)腹腔镜手术中的应用效果。方法选取2020年3月至2021年4月于三峡大学附属第二人民医院行腹腔镜手术治疗的86例EC患者为研究对象,按随机数表法分为观察组与对照组,每组各43例。对照组行常规盆腔淋巴结切除联合肾血管水平腹主动脉旁淋巴结清扫术,观察组在对照组手术基础上采用骶前淋巴结清扫术。比较两组患者的手术情况(手术时间、术中出血量、术后排气时间、住院时间、淋巴结清扫数目)、围手术期并发症(血管损伤、乳糜漏、交感干损伤、肠损伤、淋巴囊肿)、性激素水平[雌二醇(E_(2))、孕酮(P)]、生活质量[癌症患者生命质量测定表(FACT-G)]、近期复发率。结果两组患者手术时间、术后排气时间、住院时间、并发症发生率比较,差异无统计学意义(P>0.05)。观察组术中出血量、淋巴结清扫数目、术后3个月的P水平高于对照组,术后3个月的E_(2)水平、术后6个月的FACT-G各维度得分及总分均低于对照组,差异有统计学意义(P<0.05)。术后1年,观察组复发率为2.33%(1/43)低于对照组的13.95%(6/43),差异有统计学意义(χ^(2)=3.888,P=0.049)。结论肾血管水平腹主动脉旁淋巴结+骶前淋巴结清扫能更完全清除EC患者淋巴结,同时对术后恢复无不利影响。

Objective To investigate the application effect of renal vascular level abdominal paraaortic lymph node combined with presacral lymph node dissection in laparoscopic surgery for endometrial carcinoma(EC).Methods A total of 86 patients with EC who underwent laparoscopic surgery in the Second People’s Hospital Affiliated to China Three Gorges University from March 2020 to April 2021 were selected and divided into the observation group(n=43)and the control group(n=43)according to the random number table method.Patients in the control group were treated with conventional pelvic lymphadenectomy combined with renal vascular level abdominal paraaortic lymph node dissection,while those in the observation group were treated with presacral lymph node dissection on the basis of operation in the control group.The operation conditions(operation time,intraoperative hemorrhage volume,postoperative exhaust time,hospitalization time,number of lymph node dissection),perioperative complications(vascular injury,chylous leakage,sympathetic trunk injury,intestinal injury,lymphocyst),gender hormone levels(estradiol[E_(2)],progesterone[P]),quality of life(functional assessment of cancer therapy-general scale[FACT-G])and rece nt relapse rate were compared between the two groups of patients.Results There were no statistically significant differences in operation time,postoperative exhaust time,hospitalization time and incidence of complications between the two groups of patients(P>0.05).The intraoperative hemorrhage volume,the number of lymph node dissection and the P level at 3 months after operation in the observation group were higher than those in the control group,while the E_(2) level at 3 months after operation and the scores of FACT-G at all dimensions and the total score of FACT-G at 6 months after operation were all lower than those in the control group,with statistically significant differences(P<0.05).One year after operation,the relapse rate in the observation group was 2.33%(1/43),lower than 13.95%(6/43)in the control group,with statistically significant difference(χ^(2)=3.888,P=0.049).Conclusion Renal vascular level abdominal paraaortic lymph node combined with presacral lymph node dissection can more completely remove the lymph nodes of EC patients,which has no adverse impact on postoperative recovery.