腹腔镜妇科恶性肿瘤手术25例临床体会
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摘要
目的探讨开展腹腔镜下妇科恶性肿瘤手术的安全性、有效性和可行性。方法回顾性分析2013年5月至2018年12月在宜兴市第四人民医院妇产科接受腹腔镜妇科恶性肿瘤手术的25例患者的临床资料。结果 25例患者中接受腹腔镜宫颈癌根治术9例,腹腔镜子宫内膜癌分期手术10例,腹腔镜卵巢肿瘤分期手术5例,腹腔镜子宫肉瘤手术1例,无一例中转开腹。术后随访,1例宫颈鳞癌ⅡA1期,术后病理盆腔淋巴结6枚阳性,术后拒绝补充放化疗,失访,追踪得知患者一年后死亡。1例子宫内膜低分化腺癌ⅢC1期,盆腔淋巴结5枚阳性,术后补充放化疗,一年半肿瘤远处转移,现在后续治疗中。其余患者均未发现异常,继续随访中。结论严格按照肿瘤规范,正确把握手术适应证,不断提高手术操作技能,掌握手术要点以及并发症防治技巧,开展腹腔镜下妇科恶性肿瘤手术是安全、可行的。
Objective To explore the safety, effectiveness, and feasibility of laparoscopic surgery for gynecologic malignancy. Methods The clinical data of 25 patients with gynecological malignant tumors who underwent laparoscopic surgery in Fourth People's Hospital of Yixing from May 2013 to December 2018 were analyzed retrospectively.Results Of the 25 patients, 9 underwent laparoscopic radical resection of cervical cancer, 10 underwent laparoscopic staging of endometrial cancer, 5 underwent laparoscopic staging of ovarian tumor, and 1 underwent laparoscopic surgery for uterine sarcoma. During the postoperative follow-up, 1 case of cervical squamous cell carcinoma in stage ⅡA1 with6 positive pathological pelvic lymph nodes after surgery refused to receive radiotherapy and chemotherapy after surgery and was lost to follow-up, who died one year later; 1 case of endometrial poorly differentiated adenocarcinoma in stage Ⅲ C1 with 5 positive pelvic lymph nodes received radiotherapy and chemotherapy after surgery, and was found with distant metastasis in one and a half years, which was now undergoing follow-up treatment. No abnormalities were found in the remaining patients, and follow-up was continued. Conclusion It is safe and feasible to carry out laparoscopic surgery for gynecological malignant tumors by strictly following the tumor standard, correctly grasping the operation indications, continuously improving the operation skills, mastering the key points of operation and the prevention and treatment of complications.
Objective To explore the safety, effectiveness, and feasibility of laparoscopic surgery for gynecologic malignancy. Methods The clinical data of 25 patients with gynecological malignant tumors who underwent laparoscopic surgery in Fourth People's Hospital of Yixing from May 2013 to December 2018 were analyzed retrospectively.Results Of the 25 patients, 9 underwent laparoscopic radical resection of cervical cancer, 10 underwent laparoscopic staging of endometrial cancer, 5 underwent laparoscopic staging of ovarian tumor, and 1 underwent laparoscopic surgery for uterine sarcoma. During the postoperative follow-up, 1 case of cervical squamous cell carcinoma in stage ⅡA1 with6 positive pathological pelvic lymph nodes after surgery refused to receive radiotherapy and chemotherapy after surgery and was lost to follow-up, who died one year later; 1 case of endometrial poorly differentiated adenocarcinoma in stage Ⅲ C1 with 5 positive pelvic lymph nodes received radiotherapy and chemotherapy after surgery, and was found with distant metastasis in one and a half years, which was now undergoing follow-up treatment. No abnormalities were found in the remaining patients, and follow-up was continued. Conclusion It is safe and feasible to carry out laparoscopic surgery for gynecological malignant tumors by strictly following the tumor standard, correctly grasping the operation indications, continuously improving the operation skills, mastering the key points of operation and the prevention and treatment of complications.
引文
[1]熊光武,李萌,朱馥丽.腹腔镜在妇科恶性肿瘤诊治中的应用与规范化问题[J].中国实用妇科与产科杂志, 2010, 26(1):13-17.
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[4]李玉宏,王晶,王玉东.腹腔镜下广泛子宫切除术:“打坎儿井”式输尿管处理[J].中国实用妇科与产科杂志, 2018, 34(8):942-944.
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[6]沈怡,王泽华.腹腔镜下和经腹广泛子宫切除及盆腔淋巴结清扫术治疗早期子宫恶性肿瘤的近期疗效分析[J].实用妇产科杂志,2010, 26(1):48-51.
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[9]蒋芳,向阳.妇科恶性肿瘤腹膜后淋巴结切除路径、要点及并发症防治[J].中国实用妇科与产科杂志, 2017, 33(12):1233-1237.
[10]徐惠成.妇科恶性肿瘤手术后排尿功能障碍的预防与处理[J].实用妇产科杂志, 2014, 30(9):653-656.
[11]曹培勇,周丽,鲁娟,等.大黄芒硝外敷联合超声介入治疗宫颈癌术后盆腔淋巴囊肿疗效观察[J].现代中西医结合杂志, 2017, 26(23):2572-2574.
[12]郎景和,王辰,瞿红,等.妇科手术和深静脉血栓形成及肺栓塞预防专家共识[J].中华妇产科杂志, 2017, 52(10):649-653.
[13]张玉泉,杨晓清.重视妇产科静脉血栓栓塞症的综合预防[J].中国实用妇科与产科杂志, 2018, 34(7):705-708.
[2]丰有吉,沈铿,主编.妇产科学[M]. 2版.北京:人民卫生出版社,2011:325-340.
[3]刘开江.主编.妇科肿瘤腹腔镜手术图解[M].北京:人民卫生出版社, 2018:90-91. 62-64.
[4]李玉宏,王晶,王玉东.腹腔镜下广泛子宫切除术:“打坎儿井”式输尿管处理[J].中国实用妇科与产科杂志, 2018, 34(8):942-944.
[5]康山.腹腔镜在子宫内膜癌治疗中的应用[J].中国实用妇科与产科杂志, 2017, 33(5):454-458.
[6]沈怡,王泽华.腹腔镜下和经腹广泛子宫切除及盆腔淋巴结清扫术治疗早期子宫恶性肿瘤的近期疗效分析[J].实用妇产科杂志,2010, 26(1):48-51.
[7]俞进,林仲秋.妇科恶性肿瘤手术中血管损伤的预防与处理[J].实用妇产科杂志, 2014, 30(9):645-647.
[8]娄阁.腹腔镜宫颈癌手术的并发症与防治[J].腹腔镜外科杂志,2009, 14(4):259-262.
[9]蒋芳,向阳.妇科恶性肿瘤腹膜后淋巴结切除路径、要点及并发症防治[J].中国实用妇科与产科杂志, 2017, 33(12):1233-1237.
[10]徐惠成.妇科恶性肿瘤手术后排尿功能障碍的预防与处理[J].实用妇产科杂志, 2014, 30(9):653-656.
[11]曹培勇,周丽,鲁娟,等.大黄芒硝外敷联合超声介入治疗宫颈癌术后盆腔淋巴囊肿疗效观察[J].现代中西医结合杂志, 2017, 26(23):2572-2574.
[12]郎景和,王辰,瞿红,等.妇科手术和深静脉血栓形成及肺栓塞预防专家共识[J].中华妇产科杂志, 2017, 52(10):649-653.
[13]张玉泉,杨晓清.重视妇产科静脉血栓栓塞症的综合预防[J].中国实用妇科与产科杂志, 2018, 34(7):705-708.