腹腔镜广泛子宫切除联合盆腔淋巴结清扫术治疗宫颈癌疗效观察

Clinical efficacy of laparoscopic hysterectomy and pelvic lymphadenectomy in the treatment of cervical cancer

目的观察腹腔镜广泛子宫切除联合盆腔淋巴结清扫术治疗宫颈癌的临床疗效。方法选取于2013年1月至2014年12月期间在我院接受治疗的43例宫颈癌患者,根据入院时间先后将患者分为观察组22例和对照组21例,两组患者均采用广泛子宫切除术和盆腔淋巴结清扫术,其中观察组患者在腹腔镜下进行,对照组患者行常规开腹术。比较两组患者的手术时间、术中出血量、摘除淋巴结个数、各项指标以及术后住院时间、并发症发生情况,以及手术前后两组患者的FACT-G评分和复发率。结果观察组患者的手术时间和术中出血量分别为(206.91±63.45)min、(311.49±135.63)ml,均明显少于对照组的(273.46±70.83)min、(410.82±114.96)ml,差异均有统计学意义(P<0.05);观察组摘除淋巴结为(22.32±5.48)个,比对照组[(19.17±5.92)个]多,但差异无统计学意义(P>0.05);观察组患者术后排气时间和排便时间分别为(2.13±1.51)d、(3.24±1.09)d,均明显短于对照组的(3.86±1.46)d、(4.65±2.14)d,拔除尿管时间为(17.82±2.49)d,明显长于对照组的(11.57±2.15)d,差异均有统计学意义(P<0.05);治疗前,两组患者的FACT-G评分比较差异无统计学意义[(48.55±5.26)分vs(49.14±5.10)分,P>0.05],手术6个月[观察组:(70.89±7.03)分、对照组:(60.43±6.38)分]和24个月[观察组:(83.74±7.25)分、对照组:(71.91±6.96)分]后,两组患者的FACT-G评分均明显提高,分别与手术前比较,差异均具有统计学意义(P<0.05),且观察组患者术后6个月、24个月的ACT-G评分明显高于对照组,两组比较差异有统计学意义(P<0.05);24个月内,观察组复发患者1例,占4.55%,对照组复发患者3例,占14.29%,但两组比较差异无统计学意义(P>0.05)。结论腹腔镜下行广泛性子宫切除术和盆腔淋巴结清扫术治疗宫颈癌患者临床疗效较好,术中出血量少、安全性高、胃肠道功能恢复快,后期复发率低,患者生活质量明显提高,值得临床推广应用。

Objective To study the clinical efficacy of laparoscopic hysterectomy and pelvic lymphadenectomy in the treatment of cervical cancer. Methods Forty-three patients of cervical cancer in our hospital from January2013 to December 2014 were enrolled in the study, which were divided into observation group(n=22) and control group(n=21) according to admission time. The two groups both applied radical hysterectomy and pelvic lymphadenectomy.The procedures were performed under laparoscopic guidance in the observation group, while conventional open surgery was used in the control group. The operation time, blood loss, number of lymph nodes removed, postoperative hospital stay, complications, FACT-G score and recurrence were observed and compared between the two groups. Results The operation time, blood loss in the observation group were significantly shorter or less than those in the control group[(206.91±63.45) min vs(273.46±70.83) min,(311.49±135.63) ml vs(410.82±114.96) ml, P<0.05]. The number of lymph nodes removed in the observation group was higher than that in the control group, but with no statistically significant difference [(22.32±5.48) vs(19.17±5.92), P>0.05]. The two groups showed statistically significant difference in postoperative exhaust time [(2.13 ± 1.51) d vs(3.86 ± 1.46) d], defecation time [(3.24 ± 1.09) d vs(4.65 ± 2.14) d], extubation time[(17.82±2.49) d vs(11.57±2.15) d], P<0.05. Before treatment, FACT-G scores showed no statistically significant difference between the two groups [(48.55±5.26) vs(49.14±5.10), P>0.05], and the scores 6 months [(70.89±7.03) in the observation group,(60.43±6.38) in the control group] and 24 months [(83.74±7.25) in the observation group,(71.91±6.96) in the control group] after treatment were significantly increased, with statistically significant difference between the two groups after treatment(P<0.05). Within 24 months, the recurrence rate was 4.55%(1/22) in the observation group, which was significantly lower than 14.29%(3/21) in the control group(P>0.05). Conclusion Laparoscopic hysterectomy and pelvic lymphadenectomy has better clinical efficacy for cervical cancer, with less blood loss, higher safety, faster recovery of gastrointestinal function, lower recurrence rate, improved quality of life, which is recommended for wide application.