腹腔镜下广泛性子宫切除术治疗子宫颈鳞状细胞癌的临床疗效
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摘要
目的探讨腹腔镜下广泛性子宫切除术+盆腔淋巴结清扫治疗子宫颈鳞状细胞癌的临床效果。方法分析2015年4月至2016年9月辽宁省葫芦岛市中心医院妇科收治的83例子宫颈鳞状细胞癌患者临床资料,按治疗方式不同分为2组:开腹组(43例,传统经腹广泛全子宫切除术+盆腔淋巴结清扫)、腹腔镜组(40例,腹腔镜下广泛性子宫切除术+盆腔淋巴结清扫)。比较2组患者术中、术后各项指标。结果开腹组ⅠB1期、ⅡA1期患者术中出血量高于腹腔镜组,手术时间、淋巴结切除数均低于腹腔镜组,差异均有统计学意义(均P <0.05);开腹组ⅠB1期、ⅡA1期患者肛门排气时间、发热时间、住院时间均高于腹腔镜组,差异均有统计学意义(均P <0.05);2组ⅠB1期患者服用止痛药比例差异无统计学意义(P> 0.05);开腹组ⅡA1期患者服用止痛药比例高于腹腔镜组(P <0.05);2组患者术中、术后并发症发生率,心理健康、生活兴致评分差异无统计学意义(均P> 0.05);开腹组和腹腔镜组身体健康评分、社会功能评分、负面效应评分差异具有统计学意义(均P <0.05)。结论腹腔镜下广泛性子宫切除术+盆腔淋巴结清扫治疗子宫颈鳞状细胞癌能减少患者术中出血量,增加淋巴结切除数量,缩短发热和住院时间,提高患者生活质量。
Objective To evaluate the clinical efficacy of laparoscopic radical hysterectomy and pelvic lymph node dissection(PLND) in cervical squamous cell carcinoma(CSCC). Methods The clinical data of 83 CSCC patients in our hospital were retrospectively analyzed. The open surgery group(n = 43) underwent traditional transabdominal radical hysterectomy and PLND,while the laparoscopy group(n = 40) underwent laparoscopic radical hysterectomy and PLND. Intraoperative and postoperative indices were compared between the two groups. Results The intraoperative bleeding volume in stage ⅠB1 and ⅡAl patients in the open surgery group was greater than in the laparoscopy group. The operative duration was shorter and fewer lymph nodes were dissected in the open surgery group than in the laparoscopy group(P < 0.05). The time to flatus,fever duration,and hospital stay in stage ⅠB1 and ⅡA1 patients in the open surgery group were longer than in the laparoscopy group(P < 0.05). The frequency of painkiller use in stage ⅡA1 patients in the open surgery group was greater than in the laparoscopy group(P < 0.05). There was no statistical difference in the incidence of intraoperative and postoperative complications between the ⅠB1 and ⅡA1 groups(P > 0.05). The physical fitness and social function scores and the adverse effects were significantly different in the open surgery group from those in the laparoscopy group(P < 0.05). Conclusion Laparoscopic radical hysterectomy and PLND for CSCC can reduce intraoperative bleeding volume,increase the number of lymph nodes dissected,shorten the fever duration and hospital stay,and increase the quality of life.
Objective To evaluate the clinical efficacy of laparoscopic radical hysterectomy and pelvic lymph node dissection(PLND) in cervical squamous cell carcinoma(CSCC). Methods The clinical data of 83 CSCC patients in our hospital were retrospectively analyzed. The open surgery group(n = 43) underwent traditional transabdominal radical hysterectomy and PLND,while the laparoscopy group(n = 40) underwent laparoscopic radical hysterectomy and PLND. Intraoperative and postoperative indices were compared between the two groups. Results The intraoperative bleeding volume in stage ⅠB1 and ⅡAl patients in the open surgery group was greater than in the laparoscopy group. The operative duration was shorter and fewer lymph nodes were dissected in the open surgery group than in the laparoscopy group(P < 0.05). The time to flatus,fever duration,and hospital stay in stage ⅠB1 and ⅡA1 patients in the open surgery group were longer than in the laparoscopy group(P < 0.05). The frequency of painkiller use in stage ⅡA1 patients in the open surgery group was greater than in the laparoscopy group(P < 0.05). There was no statistical difference in the incidence of intraoperative and postoperative complications between the ⅠB1 and ⅡA1 groups(P > 0.05). The physical fitness and social function scores and the adverse effects were significantly different in the open surgery group from those in the laparoscopy group(P < 0.05). Conclusion Laparoscopic radical hysterectomy and PLND for CSCC can reduce intraoperative bleeding volume,increase the number of lymph nodes dissected,shorten the fever duration and hospital stay,and increase the quality of life.
引文
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[9]陈光元,黄平,谢家滨,等.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[J].海南医学,2016,27(6):932-934.DOI:10.3969/j.issn.1003-6350.2016.06.025.
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[11]冯秀山,陈佩芳.腹腔镜下子宫颈癌根治术与经腹手术的对比研究[J].福建医科大学学报,2016,50(6):428-430.
[12]祝莉,曲丽霞,权丽丽.两种不同手术方式治疗早期宫颈癌的手术参数和术后膀胱功能恢复指标的差异[J].实用癌症杂志,2017,32(10):1688-1691.DOI:10.3969/j.issn.1001-5930.2017.10.036.
[13]覃菊芳.腹腔镜与开腹子宫广泛性切除术治疗Ⅰa2~Ⅱb期子宫颈癌的安全性及远期肿瘤结局[J].腹腔镜外科杂志,2017,22(4):281-284.DOI:10.13499/j.cnki.fqjwkzz.2017.04.281.
[14]莫轶晖,杨丽丽.腹腔镜下广泛性子宫切除术和经腹广泛性子宫切除术治疗早期子宫颈癌的临床研究[J].中国性科学,2016,25(2):51-53.DOI:10.3969/j.issn.1672-1993.2016.02.017.
[15]王雅芹,孙立新.腹腔镜与开腹手术治疗早期宫颈癌的对比研究[J].中国药物与临床,2017,17(6):899-901.DOI:10.11655/zgywylc2017.06.051.
[16]夏欢,曹莉莉,蒋璐频,等.腹腔镜下保留盆腔自主神经的广泛性子宫切除术治疗早期宫颈癌的安全性及疗效的临床研究[J].实用妇产科杂志,2016,32(10):763-766.
[2]BASTA P,JACH R,LASKOWICZ L,et al.Conization and radical vaginal trachelectomy with laparoscopic lymphadenectomy in fertility-sparing surgical treatment of cervical cancer[J].Ginekol Pol,2015,86(8):590-597.
[3]涂澜涛,曾四元,梁美蓉,等.腹腔镜与经腹宫颈癌手术并发症的对比分析[J].中国内镜杂志,2016,22(7):61-65.DOI:10.3969/j.issn.1007-1989.2016.07.015.
[4]汤钊猷.现代肿瘤学[M].上海:复旦大学出版社,2011:569-571.
[5]胡冬梅,乔友林,宋桂荣,等.宫颈癌患者生命质量评价量表的编制及测评[J].肿瘤,2012,32(5):349-354.DOI:10.3781/j.issn.1000-7431.2012.05.007.
[6]KONG TW,CHANG SJ,LEE J,et al.Comparison of laparoscopic versus abdominal radical hysterectomy for FIGO stageⅠB andⅡA cervical cancer with tumor diameter of 3 cm or greater[J].Int J Gynecol Cancer,2014,24(2):280-288.DOI:10.1097/IGC.0000000000000052.
[7]HUANG SG,QIN J,CHEN J,et al.Laparoscopic surgery inhibits the proliferation and metastasis of cervical cancer cells[J].Int J Clin Exp Med,2015,8(9):16543-16549.
[8]杨露,杨萍,李东林,等.腹腔镜与开腹行子宫广泛性切除术治疗Ⅰa2~Ⅱb期子宫颈癌安全性及有效性的比较[J].中华妇产科杂志,2015,50(12):915-922.DOI:10.3760/cma.j.issn.0529-567x.2015.12.007.
[9]陈光元,黄平,谢家滨,等.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[J].海南医学,2016,27(6):932-934.DOI:10.3969/j.issn.1003-6350.2016.06.025.
[10]杨琳,李慧敏,朱艳.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.DOI:10.3969/j.issn.1004-8189.2017.11.009.
[11]冯秀山,陈佩芳.腹腔镜下子宫颈癌根治术与经腹手术的对比研究[J].福建医科大学学报,2016,50(6):428-430.
[12]祝莉,曲丽霞,权丽丽.两种不同手术方式治疗早期宫颈癌的手术参数和术后膀胱功能恢复指标的差异[J].实用癌症杂志,2017,32(10):1688-1691.DOI:10.3969/j.issn.1001-5930.2017.10.036.
[13]覃菊芳.腹腔镜与开腹子宫广泛性切除术治疗Ⅰa2~Ⅱb期子宫颈癌的安全性及远期肿瘤结局[J].腹腔镜外科杂志,2017,22(4):281-284.DOI:10.13499/j.cnki.fqjwkzz.2017.04.281.
[14]莫轶晖,杨丽丽.腹腔镜下广泛性子宫切除术和经腹广泛性子宫切除术治疗早期子宫颈癌的临床研究[J].中国性科学,2016,25(2):51-53.DOI:10.3969/j.issn.1672-1993.2016.02.017.
[15]王雅芹,孙立新.腹腔镜与开腹手术治疗早期宫颈癌的对比研究[J].中国药物与临床,2017,17(6):899-901.DOI:10.11655/zgywylc2017.06.051.
[16]夏欢,曹莉莉,蒋璐频,等.腹腔镜下保留盆腔自主神经的广泛性子宫切除术治疗早期宫颈癌的安全性及疗效的临床研究[J].实用妇产科杂志,2016,32(10):763-766.