改良腹腔镜下根治性子宫切除术在宫颈癌手术治疗中的临床价值

Clinical value of modified laparoscopic radical hysterectomy in surgical treatment of cervical cancer

目的探讨改良腹腔镜下根治性子宫切除术在宫颈癌手术治疗中的临床价值。方法回顾性分析2021年1月至2022年12月就诊于本院并行手术治疗的90例早期宫颈癌患者的临床资料,其中腹腔镜下封闭宫颈、不使用举宫器(简称免举宫)的改良腹腔镜下根治性子宫切除术(腹腔镜组)患者42例;开腹根治性子宫切除术(开腹组)患者48例。结果所有患者均顺利完成手术。两组手术时间、术中输血率比较,差异均无统计学意义(P>0.05);腹腔镜组较开腹组术后住院时间短、术中出血量、术后第1天及第2天血红蛋白下降值少(P<0.05);腹腔镜组较开腹组术后腹部切口愈合不良的风险下降(P<0.05);腹腔镜组与开腹组术后输尿管瘘、肠梗阻、淋巴漏、肺炎、盆腔感染的发生率及尿管拔除时间比较,差异均无统计学意义(P>0.05);腹腔镜组较开腹组28天内尿管拔除成功率高、脉管癌栓阳性率低(P<0.05)。结论封闭宫颈免举宫改良腹腔镜下根治性子宫切除术安全可行,可作为早期宫颈癌患者首选的手术方式之一。

Objective To explore the clinical value of modified laparoscopic radical hysterectomy in surgical treatment of cervical cancer.Methods The clinical data of 90 patients who underwent early-stage cervical cancer and received cervical cancer radical resection in our hospital from January 2021 to December 2022 were retrospectively analyzed,which underwent modified laparoscopic radical hysterectomy with suturing vagina to block the cervix without lifting uterine manipulator in the laparoscopic group(42 cases),and traditional open radical hysterectomy in open group(48 cases).Results All patients'surgeries were completed.There were no statistical difference in the postoperative hospital stays,blood transfusion posibilaty,or hemoglobin reduction on the first and second day between the two groups(P>0.05).The risk of poor healing of abdominal incision in the laparoscoic group was lower than open group(P<0.05).There was no statistical difference in the ureteral leakage.Intestinal obstruction,lymphorrhagia,pelvic infection and removal time of urinary catheter between the two groups(P>0.05).The rate of removal of the urinary catheter within 28 days in the laparoscopic group was higher than open group(P<0.05),and the positive rate of vascular cancer thrombus was lower than open group(P<0.05).Conclusions Laparoscopic radical resection which is cervix blockade by suturing the vagina without lifting the uterine manipulator is safe and feasible and can be one of the primary surgical treatments for early cervical cancer patients.