子宫肿瘤及早期宫颈癌腹腔镜手术近、远期疗效观察
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摘要
目的探讨子宫肿瘤及早期宫颈癌腹腔镜手术的近期及远期疗效。方法选择良性子宫肿瘤患者(60例)和早期宫颈癌患者(60例),分别为A、B 2组。A、B组均随机等分为2组,一组行腹腔镜,一组行开腹手术。①记录患者手术时长,失血量、肛门排气时间、尿管留置时间、住院时间,其中B组加记录淋巴切除个数。②记录术中、术后(住院期间)并发症发生情况,统计尿失禁率及排便异常率以评估术后盆底功能。③使用女性性功能量表(FSFI)评估术后1个月性功能情况;对A组患者进行远期随访(1年),记录1年复发情况和生存情况。结果①A组:与开腹组相比,腹腔镜组手术用时更短,失血量更少,肛门排气时间更短,尿管留置时间更短,住院时间更短,差异有统计学意义(P <0. 05);B组:与开腹组相比,腹腔镜组失血量更少,肛门排气时间更短,尿管留置时间更短,住院时间更短,差异有统计学意义(P<0. 05)。②A组:腹腔镜组与开腹组术中并发症发生率、术后并发症发生率、尿失禁率、排便异常率等,差异均无统计学意义(P> 0. 05); B组:腹腔镜组排便异常率较开腹组低(P <0. 05),其余均无统计学差异(P> 0. 05)。③腹腔镜组FSFI各项分值较开腹组高(P <0. 05)。④A组腹腔镜组与开腹组1年总复发率、总生存率、无瘤生存率比较,差异均无统计学意义(P> 0. 05)。结论与开腹术相比,腹腔镜手术用于子宫肿瘤及早期宫颈癌中更利于短期恢复,但在远期预后及生活质量上二者相当。
Objective To analyze the short-term and long-term curative effect of laparoscopic surgery for uterine tumors and early cervical cancer. Methods Patients with benign uterine tumors( 60 patients) and patients with early cervical cancer( 60 patients) were selected as A and B groups. Groups A and B were randomly divided into 2 groups,one group underwent laparoscopic surgery and one group underwent open surgery. ①The patients were recorded for duration of surgery,blood loss,anal exhaust time,catheter retention time,length of stay,and group B plus the number of lymphatic resections recorded. ②Recorded the intraoperative and postoperative( in hospital) complications and statisticsed urinary incontinence rate and defecation abnormality rate to assess postoperative pelvic floor function. ③ Used the female sexual function scale( FSFI) to assess postoperative one month sexual function situation. Long-term follow-up( one year) was performed on group A,and 1-year recurrence and survival were recorded. Results ①Group A: Compared with laparotomy group,the laparoscopic group had a shorter operation time,less blood loss,shorter anus exhaust time,shorter indwelling time of the urinary catheter,and shorter hospital stay. The differences were statistically significant( P < 0. 05); Group B: Compared with laparotomy group,laparoscopic group had less blood loss,shorter anus exhaust time,shorter indwelling time of urinary catheter and shorter hospital stay,the differences were statistically significant( P < 0. 05). ②In group A,the incidence of intraoperative complications,incidence of postoperative complications,incontinence rate and abnormal rate of defecation in laparoscopic group and laparotomy group were not statistically different( P > 0. 05). In group B,the abnormal rate of defecation in the laparoscopic group was lower than that in the laparotomy group( P < 0. 05),and there were no statistical differences in others( P > 0. 05). ③The scores of FSFI in laparoscopic group were higher than those in laparotomy group( P < 0. 05). ④There was no significant difference in total recurrence rate,overall survival rate,and disease-free survival rate between the laparoscopic group and the laparotomy group in the group A( P > 0. 05). Conclusion Compared with laparotomy,laparoscopy is more useful for short-term recovery in uterine tumors and early cervical cancer,but it is comparable in terms of long-term prognosis and quality of life.
Objective To analyze the short-term and long-term curative effect of laparoscopic surgery for uterine tumors and early cervical cancer. Methods Patients with benign uterine tumors( 60 patients) and patients with early cervical cancer( 60 patients) were selected as A and B groups. Groups A and B were randomly divided into 2 groups,one group underwent laparoscopic surgery and one group underwent open surgery. ①The patients were recorded for duration of surgery,blood loss,anal exhaust time,catheter retention time,length of stay,and group B plus the number of lymphatic resections recorded. ②Recorded the intraoperative and postoperative( in hospital) complications and statisticsed urinary incontinence rate and defecation abnormality rate to assess postoperative pelvic floor function. ③ Used the female sexual function scale( FSFI) to assess postoperative one month sexual function situation. Long-term follow-up( one year) was performed on group A,and 1-year recurrence and survival were recorded. Results ①Group A: Compared with laparotomy group,the laparoscopic group had a shorter operation time,less blood loss,shorter anus exhaust time,shorter indwelling time of the urinary catheter,and shorter hospital stay. The differences were statistically significant( P < 0. 05); Group B: Compared with laparotomy group,laparoscopic group had less blood loss,shorter anus exhaust time,shorter indwelling time of urinary catheter and shorter hospital stay,the differences were statistically significant( P < 0. 05). ②In group A,the incidence of intraoperative complications,incidence of postoperative complications,incontinence rate and abnormal rate of defecation in laparoscopic group and laparotomy group were not statistically different( P > 0. 05). In group B,the abnormal rate of defecation in the laparoscopic group was lower than that in the laparotomy group( P < 0. 05),and there were no statistical differences in others( P > 0. 05). ③The scores of FSFI in laparoscopic group were higher than those in laparotomy group( P < 0. 05). ④There was no significant difference in total recurrence rate,overall survival rate,and disease-free survival rate between the laparoscopic group and the laparotomy group in the group A( P > 0. 05). Conclusion Compared with laparotomy,laparoscopy is more useful for short-term recovery in uterine tumors and early cervical cancer,but it is comparable in terms of long-term prognosis and quality of life.
引文
[1]刘琦,滕慧,张承,等.子宫肿瘤微创手术后肿瘤转移原因分析〔J〕.医学研究生学报,2016,29(5):522-524.
[2]杨琳,李慧敏,朱艳,等.腹腔镜治疗恶性子宫肿瘤的临床效果及对盆底、性功能的影响〔J〕.中国计划生育学杂志,2017,25(11):764-767.
[3]王凯丽,郭瑞霞,苑中甫,等.腹腔镜下子宫肌瘤剔除术后腹膜播散性平滑肌瘤病10例临床分析〔J〕.中华妇产科杂志,2017,52(8):533-538.
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[5]姚秀玲,刘秀云,赵伟,等.腹腔镜与宫腔镜治疗子宫黏膜下肌瘤对卵巢功能、免疫功能及性生活质量的影响〔J〕.医学临床研究,2016,33(5):838-841,845.
[6]胡玲玲,彭勃.阴式与腹腔镜下剔除子宫肌瘤的效果比较〔J〕.国际妇产科学杂志,2015,42(3):286-287,305.
[7]李瑞娟,孙亚林,刘清华,等.腹腔镜联合子宫动脉栓塞术治疗子宫肌瘤的疗效分析〔J〕.医学临床研究,2015,32(10):1889-1891.
[8]黄晓晖,曾俐琴,金文艳,等.腹腔镜术后腹膜播散性平滑肌瘤病及文献复习〔J〕.中华妇幼临床医学杂志(电子版),2017,13(2):183-188.
[9]巴哈尔古丽·阿不来提,热依汗姑丽·托乎提.传统开腹术与腹腔镜下子宫肌瘤剔除术对妊娠结局、肌瘤残留及复发情况的影响〔J〕.医学临床研究,2016,33(7):1431-1432.
[10]王云洁,张书筠.腹腔镜下子宫肌瘤切除术对内分泌水平及炎症因子的影响〔J〕.医学临床研究,2017,34(4):819-821.
[11]冯九香,李婉萍.腹腔镜下子宫肌瘤剔除术对患者预后及血清疼痛指标的影响〔J〕.医学临床研究,2018,35(1):108-110.
[12]李瑞娟,刘清华,潘德超,等.腹腔镜多发性子宫肌瘤剔除术后生育状况及相关影响因素分析〔J〕.医学临床研究,2015,32(12):2449-2451.
[13]李雪梅.腹腔镜子宫切除术对早期子宫颈癌患者预后和生存质量影响〔J〕.现代仪器与医疗,2016,22(1):47-49,57.
[14]张卉.腹腔镜下病灶切除联合子宫动脉阻断术治疗子宫腺肌病48例〔J〕.山东医药,2016,56(3):80-81.
[15]金晶,王燕,段洁,等.腹腔镜手术治疗子宫恶性肿瘤的临床效果〔J〕.中国医药导报,2016,13(2):57-60.
[2]杨琳,李慧敏,朱艳,等.腹腔镜治疗恶性子宫肿瘤的临床效果及对盆底、性功能的影响〔J〕.中国计划生育学杂志,2017,25(11):764-767.
[3]王凯丽,郭瑞霞,苑中甫,等.腹腔镜下子宫肌瘤剔除术后腹膜播散性平滑肌瘤病10例临床分析〔J〕.中华妇产科杂志,2017,52(8):533-538.
[4]王文翔,海静,高玉霞,等.腹腔镜保留盆腔神经的广泛子宫切除治疗子宫肿瘤〔J〕.中华腔镜外科杂志(电子版),2016,9(3):161-164.
[5]姚秀玲,刘秀云,赵伟,等.腹腔镜与宫腔镜治疗子宫黏膜下肌瘤对卵巢功能、免疫功能及性生活质量的影响〔J〕.医学临床研究,2016,33(5):838-841,845.
[6]胡玲玲,彭勃.阴式与腹腔镜下剔除子宫肌瘤的效果比较〔J〕.国际妇产科学杂志,2015,42(3):286-287,305.
[7]李瑞娟,孙亚林,刘清华,等.腹腔镜联合子宫动脉栓塞术治疗子宫肌瘤的疗效分析〔J〕.医学临床研究,2015,32(10):1889-1891.
[8]黄晓晖,曾俐琴,金文艳,等.腹腔镜术后腹膜播散性平滑肌瘤病及文献复习〔J〕.中华妇幼临床医学杂志(电子版),2017,13(2):183-188.
[9]巴哈尔古丽·阿不来提,热依汗姑丽·托乎提.传统开腹术与腹腔镜下子宫肌瘤剔除术对妊娠结局、肌瘤残留及复发情况的影响〔J〕.医学临床研究,2016,33(7):1431-1432.
[10]王云洁,张书筠.腹腔镜下子宫肌瘤切除术对内分泌水平及炎症因子的影响〔J〕.医学临床研究,2017,34(4):819-821.
[11]冯九香,李婉萍.腹腔镜下子宫肌瘤剔除术对患者预后及血清疼痛指标的影响〔J〕.医学临床研究,2018,35(1):108-110.
[12]李瑞娟,刘清华,潘德超,等.腹腔镜多发性子宫肌瘤剔除术后生育状况及相关影响因素分析〔J〕.医学临床研究,2015,32(12):2449-2451.
[13]李雪梅.腹腔镜子宫切除术对早期子宫颈癌患者预后和生存质量影响〔J〕.现代仪器与医疗,2016,22(1):47-49,57.
[14]张卉.腹腔镜下病灶切除联合子宫动脉阻断术治疗子宫腺肌病48例〔J〕.山东医药,2016,56(3):80-81.
[15]金晶,王燕,段洁,等.腹腔镜手术治疗子宫恶性肿瘤的临床效果〔J〕.中国医药导报,2016,13(2):57-60.