腹腔镜与开腹手术治疗早期(Ⅰ～Ⅱ期)卵巢癌有效性、安全性的对比研究
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摘要
目的:比较经腹腔镜与开腹手术治疗早期卵巢癌的有效性、安全性。方法:选取2014年6月至2017年9月收治的96例卵巢癌患者,按随机数字表法分为观察组(腹腔镜手术)与对照组(开腹手术),每组48例。比较两组手术时间、术中出血量、淋巴结清扫数量、术中并发症发生率、术后排气时间、下床活动时间、住院时间、术后首次化疗时间、术后并发症总发生率,以及随访至2018年4月的复发率、死亡率。结果:两组手术时间、术中并发症发生率差异无统计学意义(P>0.05);观察组术中出血量少于对照组,淋巴结清扫数量多于对照组,差异有统计学意义(P<0.05);观察组术后排气时间、下床活动时间、住院时间、术后首次化疗时间均短于对照组,差异有统计学意义(P<0.05);观察组术后并发症总发生率(16.7% vs. 35.4%)低于对照组,差异有统计学意义(P<0.05)。两组随访期间均无失访病例,复发率分别为10.4%与6.3%,死亡率均为4.2%,差异无统计学意义(P>0.05)。结论:腹腔镜手术治疗早期卵巢癌可减少术中出血与术后并发症,加快术后恢复,同时可获得与开腹手术相当的远期预后,有效性与安全性均较高,值得推广。
Objective:To compare the effectiveness and safety of laparoscopic and open surgery for early ovarian cancer.Methods: A total of 96 patients with ovarian cancer from Jun.2014 to Sep. 2017 were randomlydivided into observation group and control group,with 48 cases in each group.The observation group underwent laparoscopic surgery,and the control group received open surgery.The operative time,intraoperative blood loss,number ofdissected lymph node,incidence of intraoperative complications,postoperative venting time,ambulation time,hospitalization time,postoperative first chemotherapy time,the total incidence of postoperative complications,relapse rate and mortality of follow-up to Apr.2018 were compared between the two groups. Results: There were no significantdifferences in the operation time or the incidence of intraoperative complications between the two groups(P>0.05).The intraoperative blood loss in the observation group was less than that in the control group,and the number ofdissected lymph node was higher than the control group,and thedifference was statistically significant(P<0.05).The postoperative venting time,ambulation time,hospitalization time,postoperative first chemotherapy time in the observation group were shorter than those in the control group(P<0.05).The total incidence of postoperative complications in the observation group was 16.7%,which was lower than 35.4% in the control group,thedifference was statistically significant(P<0.05).There were no cases of lost follow-upduring the follow-up period in the both groups.The recurrence rate was 10.4% and 6.3%,respectively,and the mortality was 4.2% in both groups,thedifference was not statistically significant(P>0.05).Conclusions: Laparoscopic surgery for early ovarian cancer can reduce intraoperative bleeding and postoperative complications,speed up postoperative recovery,and can obtain a long-term prognosis comparable to open surgery,with higher efficacy and safety,is worthy of promotion.
Objective:To compare the effectiveness and safety of laparoscopic and open surgery for early ovarian cancer.Methods: A total of 96 patients with ovarian cancer from Jun.2014 to Sep. 2017 were randomlydivided into observation group and control group,with 48 cases in each group.The observation group underwent laparoscopic surgery,and the control group received open surgery.The operative time,intraoperative blood loss,number ofdissected lymph node,incidence of intraoperative complications,postoperative venting time,ambulation time,hospitalization time,postoperative first chemotherapy time,the total incidence of postoperative complications,relapse rate and mortality of follow-up to Apr.2018 were compared between the two groups. Results: There were no significantdifferences in the operation time or the incidence of intraoperative complications between the two groups(P>0.05).The intraoperative blood loss in the observation group was less than that in the control group,and the number ofdissected lymph node was higher than the control group,and thedifference was statistically significant(P<0.05).The postoperative venting time,ambulation time,hospitalization time,postoperative first chemotherapy time in the observation group were shorter than those in the control group(P<0.05).The total incidence of postoperative complications in the observation group was 16.7%,which was lower than 35.4% in the control group,thedifference was statistically significant(P<0.05).There were no cases of lost follow-upduring the follow-up period in the both groups.The recurrence rate was 10.4% and 6.3%,respectively,and the mortality was 4.2% in both groups,thedifference was not statistically significant(P>0.05).Conclusions: Laparoscopic surgery for early ovarian cancer can reduce intraoperative bleeding and postoperative complications,speed up postoperative recovery,and can obtain a long-term prognosis comparable to open surgery,with higher efficacy and safety,is worthy of promotion.
引文
[1]赵鲁文,于爱军,张玉娟,等.腹腔镜评估晚期卵巢癌患者能否行满意的肿瘤细胞减灭术的Meta分析[J].中国医药导报,2016,13(29):56-62.
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[10]陈小玲,周国萍.早期卵巢癌腹腔镜手术治疗新进展[J].海南医学,2014,25(8):1164-1165.
[11]韦海苏.腹腔镜及开放手术在结直肠癌肝脏转移病灶切除术中的疗效比较[J].结直肠肛门外科,2017,23(4):545-547.
[12] Badgwell B,Blum M,Das P,et al.Lessons learned from a phase II clinical trial of laparoscopic HIPEC for gastric cancer[J].Surg Endosc,2018,32(1):512.
[13] Liang H,Guo H,Zhang C,et al.Feasibility and outcome of primary laparoscopic cytoreductive surgery for advanced epithelial ovarian cancer:a comparison to laparotomic surgery in retrospective cohorts[J].Oncotarget,2017,8(68):113239-113247.
[14] Falik RC.Regarding"Robotic Versus Laparoscopic Staging for Early Ovarian Cancer:A Case-matched Control Study"[J].J Minim Invasive Gynecol,2017,24(6):1049.
[15] Sheng X,Zhong Y,Lu C,et al.Clinical study of hereditary ovarian cancer syndrome in Shandong province,East China[J].Int J Gynaecol Obstet,2018,141(2):234-239.
[16] Lamblin G,Thiberville G,Bansac Lamblin A,et al.What haemostatic technique should we use for opportunistic salpingectomy during benign laparoscopic hysterectomy?[J].Gynecol Obstet Fertil Senol,2017,45(9):453-459.
[17] Ishiguro S,Komatsu S,Komaya K,et al.Sphincter-preserving surgery for recurrent pelvic malignancy using a hybrid procedure of open laparotomy and transanal endoscopic approach[J].Surg Case Rep,2018,4(1):33.
[18] Yoo JG,Kim WJ,Lee KH.Single-Site Robot-Assisted Laparoscopic Staging Surgery for Presumed Clinically Early-Stage Ovarian Cancer[J].J Minim Invasive Gynecol,2018,25(3):380-381.
[2]韩翠,徐艳,卢美松,等.腹腔镜治疗早期卵巢癌的围术期护理干预对并发症及生活质量的影响[J].中国医药导报,2016,13(29):149-152.
[3]王刚,陈扬平.晚期卵巢癌腹腔镜下肿瘤细胞减灭术的临床相关问题[J/CD].中华妇幼临床医学杂志(电子版),2016,12(4):373-378.
[4]王雪梅,马欢,刘婉,等.腹腔镜与开腹手术对早期卵巢癌临床疗效评价的随机对照分析[J].中国妇幼健康研究,2016,27(8):991-993.
[5]李菁,沈立翡,朱岚,等.新辅助化疗联合间隔减瘤术在晚期卵巢癌中的临床应用研究[J].中国计划生育和妇产科,2015,27(11):53-57.
[6]刘瑾杨,张克强.晚期卵巢癌患者肿瘤减灭术前评估方法的进展[J].中南大学学报(医学版),2017,42(7):854-859.
[7] Lamblin G,Meysonnier C,Moret S,et al.Opportunistic salpingectomy during vaginal hysterectomy for a benign pathological condition[J].Int Urogynecol J,2018,29(5):715-721.
[8] Ceccaroni M,Roviglione G,Bruni F,et al.Laparoscopy for primary cytoreduction with multivisceral resections in advanced ovarian cancer:prospective validation."The times they are a-changin"?[J].Surg Endosc,2018,32(4):2026-2037.
[9]蒲玉华.腹腔镜手术在复发性卵巢癌中的应用价值[J].实用妇产科杂志,2015,31(9):711-713.
[10]陈小玲,周国萍.早期卵巢癌腹腔镜手术治疗新进展[J].海南医学,2014,25(8):1164-1165.
[11]韦海苏.腹腔镜及开放手术在结直肠癌肝脏转移病灶切除术中的疗效比较[J].结直肠肛门外科,2017,23(4):545-547.
[12] Badgwell B,Blum M,Das P,et al.Lessons learned from a phase II clinical trial of laparoscopic HIPEC for gastric cancer[J].Surg Endosc,2018,32(1):512.
[13] Liang H,Guo H,Zhang C,et al.Feasibility and outcome of primary laparoscopic cytoreductive surgery for advanced epithelial ovarian cancer:a comparison to laparotomic surgery in retrospective cohorts[J].Oncotarget,2017,8(68):113239-113247.
[14] Falik RC.Regarding"Robotic Versus Laparoscopic Staging for Early Ovarian Cancer:A Case-matched Control Study"[J].J Minim Invasive Gynecol,2017,24(6):1049.
[15] Sheng X,Zhong Y,Lu C,et al.Clinical study of hereditary ovarian cancer syndrome in Shandong province,East China[J].Int J Gynaecol Obstet,2018,141(2):234-239.
[16] Lamblin G,Thiberville G,Bansac Lamblin A,et al.What haemostatic technique should we use for opportunistic salpingectomy during benign laparoscopic hysterectomy?[J].Gynecol Obstet Fertil Senol,2017,45(9):453-459.
[17] Ishiguro S,Komatsu S,Komaya K,et al.Sphincter-preserving surgery for recurrent pelvic malignancy using a hybrid procedure of open laparotomy and transanal endoscopic approach[J].Surg Case Rep,2018,4(1):33.
[18] Yoo JG,Kim WJ,Lee KH.Single-Site Robot-Assisted Laparoscopic Staging Surgery for Presumed Clinically Early-Stage Ovarian Cancer[J].J Minim Invasive Gynecol,2018,25(3):380-381.