腹腔镜与剖腹手术治疗早期子宫颈癌37例临床分析

A comparision study between laparoscopic and open operation for the treatment of early-stage cervix cancer :Clinical analysis of 37 cases

目的 探讨腹腔镜手术治疗早期子宫颈癌的价值。 方法 对 18例临床Ⅰb～Ⅱa 期宫颈癌施行腹腔镜下广泛全子宫切除和盆腔淋巴结清扫术 (腹腔镜组 ) ,其中Ⅰb 期 17例 ,Ⅱa1例。同期 19例早期子宫颈癌行开腹广泛全子宫切除和盆腔淋巴结清扫术 (剖腹组 ) ,比较两种术式的手术时间、术中出血量、术后恢复情况及手术并发症等。 结果 腹腔镜组平均手术时间 (2 72 8min± 80 3min)与开腹组 (2 2 6 5min± 6 6 8min)无明显统计学差异 (t=1 92 1,P =0 0 6 3)。腹腔镜组平均切除淋巴结 15 6± 5 1个 ,开腹组 16 8± 5 7个 ,两组比较差异无显著性 (t=0 6 74 ,P =0 5 0 5 )。腹腔镜组术后肠道功能恢复时间较开腹组明显缩短 (34 2hvs.6 0 7h ,P <0 0 1)。两组均无严重并发症发生。腹腔镜组术后并发症发生率为 33 3% (6 18) ,开腹组为 31 6 % (6 19) ,两组差异无显著性 (P =0 812 )。 结论 腹腔镜与剖腹手术都可作为子宫颈癌根治术的术式之一 ,腹腔镜手术具有创伤小 ,术后恢复快等优点。

Objective To explore the value of laparoscopic operations for early-stage cervix cancer. Methods Eighteen patients with Ⅰ b～Ⅱ a astage cervix cancer underwent extensive total uterectomy combined with pelvic lymphadenectomy under laparoscope (17Ⅰ b cases, 1Ⅱ a case). Concurrently, another 19 patients with the same diagnosis and approximately the same clinical features as the abovementioned 18 cases, as the control group, were treated by open extensive total uterectomy combined with pelvic lymphadenectomy. The operation time, intraoperative blood loss, postoperative recovery and complications of two groups were compared. Results No statistically significant differences were found on mean operation time between the laparoscopy group (272.8 min±80.3min) and open group (226.5 min±66.8min) (t=1.921,P=0.063). The number of removed lymph nodes was 15.6±5.1 in laparoscopy group and 16.8±5.7 in open group, without statistically significant differences (t=0.674,P=0.505). The recovery time of intestine functions in laparoscopy group (34.2 hours) was obviously shorter than that of open group (60.7 hours) (P<0.01). There were no serious complications found in two groups. The occurrence rate of other complications had no statistically significant differences between the laparoscopy group (33.3%; 6/18) and open group (31.6%; 6/19) (P=0.812). Conclusions Both laparoscopic and open operations are proper alternatives of radical excision for cervix cancer. The laparoscopic operation, however, has the advantages of minimal invasion and rapid recovery.