腹腔镜宫颈癌根治术治疗ⅠA2~ⅡA2期宫颈癌的疗效及术后复发的危险因素分析

Efficacy and risk factors of postoperative recurrence of IA2-IIA2 stage cervical carcinoma treated by laparoscopic radical resection

目的探讨腹腔镜宫颈癌根治术治疗ⅠA2~ⅡA2期宫颈癌的疗效并分析患者术后复发的危险因素。方法将96例宫颈癌患者按照手术方式的不同分为观察组52例和对照组44例,观察组患者接受腹腔镜宫颈癌根治术,对照组患者接受开腹宫颈癌根治术。比较两组患者围手术期指标及并发症发生情况,并采用单因素分析和多因素Logistic回归分析探讨宫颈癌患者术后复发的危险因素。结果观察组患者首次排气时间、住院时间均明显短于对照组,术中出血量明显少于对照组,差异均有统计学意义(P﹤0.01)。观察组患者并发症总发生率低于对照组,差异有统计学意义(P﹤0.05)。单因素分析显示,病理类型、分化程度、国际妇产科联盟(FIGO)分期、脉管癌栓情况、阴道切缘情况均可能与宫颈癌患者术后复发有关(P﹤0.05)。多因素Logistic回归分析显示,腺癌、低分化、ⅡA期、有脉管癌栓、阴道切缘阳性均是宫颈癌术后复发的危险因素(P﹤0.05)。结论ⅠA2~ⅡA2期宫颈癌患者实施腹腔镜宫颈癌根治术治疗,能减少术中出血量,缩短首次排气时间和住院时间,降低术后并发症发生率,加快患者恢复进程;同时术后存在一定比例的患者出现肿瘤复发,腺癌、低分化、ⅡA期、有脉管癌栓、阴道切缘阳性均是宫颈癌术后复发的危险因素。

Objective To investigate the efficacy of laparoscopic radical resection in the treatment of IA2-IIA2 stage cervical cancer,and to analyze the risk factors of postoperative recurrence.Method A total of 96 cervical cancer patients were divided into observation group(n=52,received laparoscopic radical cervical cancer resection)and control group(n=44,received open radical cervical cancer resection)according to different surgical methods.Perioperative indicators and complications in both groups were compared,the risk factors related to postoperative recurrence were analyzed by oneway OVA and multivariate Logistic regression.Result The first exhaust time,hospitalization time in the observation group were shorter than those in the control group,and intraoperative blood loss was less than that in the control group(P<0.01);the total incidence of complications in the observation group was lower than that in the control group(P<0.05).Univariate analysis showed that pathological classification,degree of differentiation,International Federation of Gynecology and Obstetrics(FIGO)stage,vascular tumor embolus and vaginal resection margin were related to cervical cancer postoperative recurrence(P<0.05).Multivariate Logistic regression showed that adenocarcinoma,low differentiation,IIA stage,vascular tumor embolus and positive vaginal resection margin were the risk factors for cervical cancer postoperative recurrence(P<0.05).Conclusion Laparoscopic radical resection of cervical carcinoma in IA2-IIA2 stage can effectively reduce intraoperative blood loss,shorten the first exhaust time and hospitalization time,reduce the risk of postoperative complications and improve the recovery.Some patients experienced recurrence.Adenocarcinoma,low differentiation,IIA stage,vascular tumor embolus and positive vaginal resection margin are the risk factors for cervical cancer postoperative recurrence.