吊宫联合套扎环阴道封闭在机器人辅助腹腔镜下宫颈癌根治术中的应用效果分析

Clinical efficacy of uterine suspension combining with loop ligature in robot-assisted laparoscopic radical hysterectomy

目的:探讨吊宫法联合套扎环阴道封闭术在机器人辅助腹腔镜下宫颈癌广泛性子宫切除术中的安全性及有效性。方法:回顾性分析2017年3月—2021年6月就诊于郑州大学第一附属医院并采用达芬奇机器人辅助腹腔镜下宫颈癌广泛性子宫切除术的263例ⅠA2~ⅡA2期宫颈癌患者的临床资料。所有手术均由同一术者进行,按手术方法不同将患者分为举宫组和吊宫组。举宫组(130例)术中使用举宫杯,在开放状态下切开阴道壁;吊宫组(133例)用线结牵拉悬吊子宫,并用套扎环封闭阴道后于线结下方1.5~2 cm切开阴道壁。结果:吊宫组平均手术时间短于举宫组[(241.71±57.26)min Vs(275.73±88.75)min],术中出血量少于举宫组[(81.13±61.94)ml Vs(125.88±122.29)ml],术后住院时间短于举宫组[(7.62±2.69)d Vs(9.32±4.56)d],术后并发症发生率低于举宫组(4.51%Vs 15.38%),且差异均具有统计学意义(P<0.05);比较两组患者宫旁切除长度、阴道切除长度、淋巴结切除数目、阴道壁病理切缘、无进展生存期,差异均无统计学意义(P>0.05)。结论:吊宫法联合套扎环阴道封闭术应用于机器人辅助腹腔镜宫颈癌广泛性子宫切除术有利于术后恢复,且该术式安全、可行,但其远期疗效仍需多中心大样本长期随访研究进一步证明。

Objective:To explore the safety and efficacy of uterine suspension combining with loop ligature in robotassisted laparoscopic radical hysterectomy.Methods:The clinical data of 263 patients with cervical cancer(IA2~IIA2 stage)who underwent Da Vinci robot-assisted laparoscopic radical hysterectomy in the First Affiliated Hospital of Zhengzhou University from March 2017 to June 2021 were retrospectively analyzed.All surgeries were performed by the same surgeon and divided into the uterus-lifting group and the uterine-suspension group.The uterine manipulator was used in the uterus-lifting group(130 cases)to cut the vaginal wall in the open state.In the uterine-suspension group(133 cases),the uterus was pulled and suspended with suture,and the vagina was incised 1.5-2 cm below the suture after sealing the vagina.Results:The average operative time of the uterine-suspension group was shorter than that of the uterus-lifting group[(241.71±57.26)min Vs(275.73±88.75)min],and the intraoperative blood loss was less than that of the uterus-lifting group[(81.13±61.94)ml Vs(125.88±122.29)ml].The postoperative hospital stay of the uterine suspension group was shorter than that of the uterus-lifting group[(7.62±2.69)d Vs(9.32±4.56)d],the incidence of postoperative complications was lower than that of the uterus-lifted group(4.51%Vs 15.38%),and the differences were statistically significant(P<0.05).There were no significant differences between the two groups in the length of resected parametriumand vagina,the number of resected lymph nodes,pathological margin of vaginal wall and progression-free survival(P>0.05).Conclusion:Robot-assisted laparoscopic radical hysterectomy with uterine suspension combining with loop ligature is safe and feasible.However,multi-center,large sample and long-term follow-up studies are still needed to further confirm its long-term efficacy.