经脐单孔腹腔镜盆腔淋巴结切除联合经阴道广泛子宫切除术治疗早期宫颈癌的临床疗效评价

Evaluation of the efficacy of transumbilical single-port laparoscopic pelvic lymph node resection combined with extensive vaginal hysterectomy in the treatment of early cervical cancer

目的 评价经脐单孔腹腔镜盆腔淋巴结切除联合经阴道广泛子宫切除术治疗早期宫颈癌的临床疗效。方法 收集2021年1月至2023年1月西北妇女儿童医院150早期宫颈癌患者进行前瞻性研究,按照随机数字表法将其分为对照组(n=75)与观察组(n=75)。对照组采用传统开腹手术治疗,观察组采用经脐单孔腹腔镜盆腔淋巴结切除联合经阴道广泛子宫切除术治疗。比较两组患者的手术指标(手术时间、术中出血量、淋巴结切除数目)、术后恢复指标(肛门排气时间、下床活动时间、盆腔引流时间及住院时间),并比较两组患者手术前、手术后3个月的生活功能[癌症治疗功能评估(FACT-G)量表评分]、性功能[女性性功能量表(FSFI)量表评分],手术后3个月的盆底肌肌力情况,并随访术后并发症发生情况。结果 观察组手术时间为(235.21±13.58)min,长于对照组[(219.38±10.73)min],术中出血量为(175.38±24.76)mL,少于对照组[(262.49±25.87)mL],淋巴结切除数目为(22.35±1.74)个,多于对照组[(21.61±1.64)个],差异均有统计学意义(P<0.05)。观察组的术后肛门排气时间、下床活动时间、盆腔引流时间及住院时间分别为(28.38±4.25) h、(43.25±3.25) h、(3.21±0.63)d、(7.37±1.24)d,均短于对照组[(40.22±4.73) h、(56.42±4.26) h、(4.21±0.74)d、(11.38±1.62)d],差异均有统计学意义(P<0.05)。手术后3个月,观察组患者FACT-G、FSFI评分分别为(85.13±4.92)、(30.13±1.92)分,均明显高于对照组[(74.15±4.46)、(25.15±1.46)分],盆底肌肌力分级情况明显优于对照组,差异均有统计学意义(P<0.05)。观察组术后并发症发生率为5.33%,低于对照组(17.33%),差异有统计学意义(P<0.05)。结论 经脐单孔腹腔镜盆腔淋巴结切除联合经阴道广泛子宫切除术治疗早期宫颈癌,创伤小、术后恢复快,可改善患者生活功能、性功能及盆底肌肌力,并发症少,安全有效。

Objective To evaluate the clinical efficacy of transumbilical single-port laparoscopic pelvic lymph node resection combined with extensive vaginal hysterectomy in the treatment of early cervical cancer.Methods A total of 150 patients with early cervical cancer in Northwest Women's and Children's Hospital from January 2021 to January 2023 were collected for a prospective study.The patients were divided into the control group(n=75) the and observation group(n=75) by random number table method.The control group was treated with traditional open surgery,the observation group was treated with transumbilical single-port laparoscopic pelvic lymph node resection combined with extensive vaginal hysterectomy.The surgical indicators(operation time,intraoperative blood loss,number of lymph node resections),postoperative recovery indicators,life function [the Functional Assessment of Cancer Therapy-General(FACT-G)] and sexual function[female sexual function index(FSFI)] before operation and after 3 months of operation,pelvic floor muscle strength after 3 months of operation of two groups were compared,and postoperative complications of two groups were followed up.Results The operation time of the observation group was(235.21±13.58) min,which was longer than that of the control group [(219.38±10.73) min],the intraoperative blood loss was(175.38±24.76) mL,which was lower than that of the control group [(262.49±25.87) mL],the number of lymph node resections was(22.35±1.74) nodes,which was higher than that of the control group [(21.61±1.64) nodes],and the differences were statistically significant(P<0.05).The postoperative anal exhaust time,bed activity time,pelvic drainage time,and hospitalization time of the observation group were(28.38±4.25) h,(43.25±3.25) h,(3.21±0.63) d,and(7.37±1.24) d,respectively,which were shorter than those of the control group [(40.22±4.73) h,(56.42±4.26) h,(4.21±0.74) d,and(11.38±1.62) d],and the differences were statistically significant(P<0.05).After 3 months of operation,the FACT-G and FSFI scores of the observation group were(85.13±4.92) and(30.13±1.92) points,respectively,which were significantly higher than those of the control group [(74.15±4.46) and(25.15±1.46) points],the pelvic floor muscle strength grading was significantly better than that of the control group,and the differences were statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 5.33%,which was lower than that in the control group(17.33%),and the difference was statistically significant(P<0.05).Conclusion The combination of transumbilical single-port laparoscopic pelvic lymph node resection and extensive vaginal hysterectomy in the treatment of early cervical cancer has the advantages of minimal trauma,fast postoperative recovery,improved patient life function,sexual function,and pelvic floor muscle strength,minimal complications,and were safe and effective.