机器人手术与传统开腹术治疗早期宫颈癌的效果分析

Surgical and oncological outcome of robotic surgery compared with conventional laparotomy in the management of early cervical cancer

目的比较机器人手术和开腹手术治疗ⅠA1-ⅡA2期宫颈癌患者的手术效果和肿瘤学结局。方法去回顾性分析2016年至2018年南昌大学第一附属医院妇产科收治的164例ⅠA1-ⅡA2期宫颈癌患者的临床资料,所有患者术前均未接受放疗或化疗;其中116例接受机器人手术(机器人组)根治性子宫切除术及盆腔淋巴结清扫,48例接受开腹手术(开腹手术组)。比较两手术组的手术效果和肿瘤学结局。结果两组患者在手术时间、手术并发症、盆腔淋巴结切除数、手术切缘阳性、宫旁受累和淋巴结转移方面差异均无统计学意义(P>0.05)。在手术失血量、术后住院时间和肠功能恢复方面,机器人组的结果分别优于开腹手术组(P<0.05)。机器人组68例患者术后接受辅助治疗,开腹手术组19例患者接受辅助治疗(P<0.05)。机器人组的随访时间与开腹手术组无明显差异(52.32±11.18vs.56.17±15.05月,P>0.05)。两组复发率和死亡率差异均无统计学意义(P=0.95,P=0.68)。结论与开腹手术相比,机器人手术结合术后辅助治疗对早期宫颈癌是可行和安全的,具有良好的手术效果和同等的肿瘤学结局。

Objective To compare surgical and oncological outcome of robotic surgery and laparotomy for the treatment of stageⅠA1 toⅡA2 cervical cancer.Methods A retrospective study were performed in a university-affiliated tertiary hospital between 2016 and 2018.One hundred and sixty-four patients with stageⅠA1-ⅡA2 cervical carcinoma without preoperative brachytherapy or chemotherapy were included,of whom 116 underwent robotic and 48 underwent laparotomic radical hysterectomy with pelvic lymph node dissection performed.The surgical and oncological parameters of two surgical groups were compared.Results There were no significant diferences between the two groups in operative time,intraoperative and postoperative complications,pelvic lymph node,positive surgical margins,parametrial involvement and lymph node metastasis respectively(P>0.05).In terms of blood loss,postoperative hospital stay and bowel function recovery,the outcomes of robotic group were more favorable than those of laparotomy group respectively(P<0.05).Sixty-eight patients in robotic group accepted adjuvant therapy postoperation while 19 patients in laparotomy group accepted therapy(P<0.05).No significant difference was found in follow-up time between the two groups(52.32±11.18 vs.56.17±15.05 months,P>0.05).There were no significant differences between the two groups in recurrence and death rate(P>0.05).Conclusion With adjuvant therapy postoperation,robotic surgery for early cervical cancer seems to be feasible and safe with favorable short-term surgical and equivalent oncological outcomes.