改良腹腔镜子宫广泛性切除术治疗ⅠA2~ⅠB1期

刘健; 邓招雅; 徐杰; 高龙飞; 孙一琳; 李艳

doi:10.16766/j.cnki.issn.1674-4152.001999

改良腹腔镜子宫广泛性切除术治疗ⅠA2~ⅠB1期

doi: 10.16766/j.cnki.issn.1674-4152.001999

蚌埠医学院第一附属医院妇瘤科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究项目 KJ2019A0363

详细信息

通讯作者:
刘健，E-mail: elitelj@126.com

中图分类号: R737.33 R730.56
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出版历程
- 收稿日期: 2021-02-04
- 网络出版日期: 2022-02-16

Clinical analysis of modified laparoscopic extensive hysterectomy in the treatment of stage ⅠA2 - ⅠB1 cervical cancer

Department of Gynecology and Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的比较ⅠA2~ⅠB1期子宫颈癌患者行改良腹腔镜与完全腹腔镜子宫广泛性切除术的围手术期情况。方法收集2017年2月—2020年6月蚌埠医学院第一附属医院妇瘤科收治的按国际妇产科联盟(FIGO)临床分期为ⅠA2~ⅠB1期并接受腹腔镜子宫广泛性切除术的子宫颈癌患者。回顾性分析其临床病理、手术情况和术后恢复情况。共30例患者纳入本研究，其中改良腹腔镜(免举宫杯及阴道封闭切取样本)与完全腹腔镜(有举宫杯)子宫广泛性切除术各15例。比较2组患者手术时间、出血量、切除宫旁长度、切除阴道壁长度、围手术期并发症及术后恢复情况等。结果 2组患者年龄[(50.13±7.35)岁vs. (44.80±7.46)岁]、BMI(24.26±3.57 vs. 23.48±3.01)、FIGO分期(ⅠA2/ⅠB1：4/11 vs. 1/14)以及病理类型(鳞癌/腺癌：13/2 vs. 10/5)比较，差异均无统计学意义(均P>0.05)。2组患者的手术时间[223(204, 248)min vs. 100(80, 300)min]、术中出血量[216(179, 251)mL vs. 100(76, 300)mL]、切除阴道壁长度[(3.32±0.20)cm vs. (3.49±0.29)cm]以及宫旁长度[(3.25±0.27)cm vs. (3.41±0.32)cm]比较，差异均无统计学意义(均P>0.05)。2组患者尿潴留(有/无：4/11 vs. 2/13)、深静脉血栓(有/无：3/12 vs. 1/14)、淋巴囊肿(有/无：6/9 vs. 8/7)、是否术后补充治疗(是/否：8/7 vs. 8/7)、术后排气时间[(2.80±0.41)d vs. (2.79±0.43)d]和术后住院时间[(5.13±1.64)d vs. (5.60±0.99)d]比较，差异均无统计学意义(均P>0.05)。结论改良腹腔镜子宫广泛性切除术与完全腹腔镜子宫广泛性切除术相比有着相同的安全性，值得进一步推广应用。
- 腹腔镜 /
- 改良腹腔镜 /
- 子宫颈癌 /
- 无瘤原则
Abstract: Objective To compare the perioperative conditions of modified laparoscopic and complete laparoscopic extensive hysterectomy in patients with stage ⅠA2 - ⅠB1 cervical cancer. Methods Patients who were admitted at the Department of Gynecology and Oncology of the First Affiliated Hospital of Bengbu Medical College from February 2017 to June 2020 were recruited. The patients were graded as clinical stage ⅠA2 - ⅠB1 according to the International Federation of Gynecology and Obstetrics (FIGO) and received laparoscopic extensive hysterectomy for cervical cancer. The clinical pathology, surgery and postoperative recovery of patients were retrospectively analysed. A total of 30 patients were included in this study, including 15 cases of modified laparoscopic (no lifting cup and closed vaginal resection sample) and complete laparoscopic (with lifting cup) extensive hysterectomy. The operation time, blood loss, length of parauterine resection, length of vaginal wall resection, perioperative complications and postoperative recovery were compared between the two groups. Results No statistically significant differences were observed in the age[(50.13±7.35) years vs. (44.80±7.46) years], body mass index (24.26±3.57 vs. 23.48±3.01), FIGO staging (ⅠA2/ⅠB1: 4/11 vs. 1/14) and pathological type (squamous carcinoma/adenocarcinoma: 13/2 vs. 10/5) of the two groups of patients (all P>0.05). Moreover, no statistically significant differences were observed in the operation time[223 (204, 248) min vs. 100 (80, 300) min], intraoperative blood loss[216 (179, 251) mL vs.100 (76, 300) mL], length of vaginal wall resected[(3.32±0.20) cm vs. (3.49±0.29) cm] and length of parauterine wall[(3.25±0.27) cm vs. (3.41±0.32) cm] between the two groups (all P>0.05). In addition, no significant differences were observed in urinary retention (yes/no: 4/11 vs. 2/13), deep vein thrombosis (yes/no: 3/12 vs. 1/14), lymphatic cyst (yes/no: 6/9 vs. 8/7), postoperative supplementary treatment (yes/no: 8/7 vs. 8/7), postoperative exhaust time[(2.80±0.41) d vs. (2.79±0.43) d] and postoperative hospital stay[(5.13±1.64) d vs. (5.60±0.99) d] between the two groups of patients (all P>0.05). Conclusion Modified laparoscopic extensive hysterectomy has the same safety as complete laparoscopic hysterectomy and is worthy of further promotion.
- Laparoscopy /
- Modified laparoscopy /
- Cervical cancer /
- Tumour-free principle

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表 1 2组宫颈癌患者术前指标比较

组别	例数	年龄(x±s, 岁)	BMI (x±s)	FIGO分期(例)		病理类型(例)
组别	例数	年龄(x±s, 岁)	BMI (x±s)	ⅠA2	ⅠB1	鳞癌	腺癌
改良腹腔镜组	15	50.13±7.35	24.26±3.57	4	11	13	2
完全腹腔镜组	15	44.80±7.46	23.48±3.01	1	14	10	5
t值		1.971	0.641
P值		0.059	0.527	0.330^a		0.390^a
注：^a为采用Fisher精确检验。

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表 2 2组宫颈癌患者手术中情况指标比较[M(P₂₅，P₇₅)]

组别	例数	手术时间(min)	出血量(mL)	切除阴道壁长度(x±s, cm)	切除宫旁长度(x±s, cm)
改良腹腔镜组	15	223(204, 248)	216(179, 251)	3.32±0.20	3.25±0.27
完全腹腔镜组	15	100(80, 300)	100(76, 300)	3.49±0.29	3.41±0.32
统计量		0.560^a	0.716^a	-1.810^b	-1.495^b
P值		0.575	0.474	0.081	0.146
注：^a为Z值，^b为t值。

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表 3 2组宫颈癌患者术后指标比较

组别	例数	尿潴留(例)		深静脉血栓(例)		淋巴囊肿(例)		术后补充治疗(例)		术后排气时间(x±s, d)	术后住院时间(x±s, d)
组别	例数	有	无	有	无	有	无	是	否	术后排气时间(x±s, d)	术后住院时间(x±s, d)
改良腹腔镜组	15	4	11	3	12	6	9	8	7	2.80±0.41	5.13±1.64
完全腹腔镜组	15	2	13	1	14	8	7	8	7	2.79±0.43	5.60±0.99
t值										0.092	0.944
P值		0.651^a		0.598^a		0.715^a				0.928	0.353
注：^a为采用Fisher精确检验。

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