手助腹腔镜与开腹卵巢癌肿瘤细胞减灭术的临床对比研究

发布时间：2018-03-06 02:18

  本文选题：卵巢癌　切入点：肿瘤细胞减灭术　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:随着医学技术的飞速发展,妇科恶性肿瘤的治疗从传统的开放式手术逐渐发展到微创手术,而对于卵巢癌患者的具体手术方式一直是妇科临床医师讨论的焦点,尤其是对于“多器官转移、盆腹腔致密粘连”的晚期卵巢癌患者,单单借助腹腔镜技术是远远不能独立实现满意的肿瘤细胞减灭术的。本研究探讨一种“杂交”的手术方式——手助腹腔镜手术(hand-assisted laparoscopic surgery,HALS)在卵巢癌肿瘤细胞减灭术中的应用;并将其与常规开腹手术(open surgery,OS)在卵巢癌肿瘤细胞减灭术中的应用进行初步的临床对比研究,为卵巢癌的临床治疗提供新思路。方法:1病例收集:收集自2014年11月至2016年11月在我院因卵巢癌行肿瘤细胞减灭术的58例患者,其中手助腹腔镜组(HALS组:18例)及开腹组(OS组:40例)。术前无化疗史,术后石蜡结果属于卵巢上皮性恶性肿瘤。所有病例均按照国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO 2014)手术分期标准进行分期,并给予规范的TP方案化疗。2比较两组患者一般资料:HALS组与OS组患者的年龄[(58.33±8.19)岁VS(55.95±7.29)岁,P0.05],两组患者合并症分别包括高血压、糖尿病、肥胖、低蛋白血症、盆腹腔手术史等,一般情况比较差异无统计学意义,具有可比性。3术前准备、麻醉和体位、手术。4观察指标:手术切口长度、手术时间、术中出血量、术后残留肿瘤大小、术后肠道恢复时间、术后住院时间、术后第一次化疗的时间之间的差异,两组患者术后病理结果及肿瘤分期的分布,及两组患者术后生存情况之间的差异。5统计学处理:采用SPSS 21.0统计软件进行分析,计量资料采用t检验,计数资料采用χ2检验。采用Kaplan-Meier方法描绘生存曲线。α=0.05为检验标准,P0.05认为差异有统计学意义。结果:1 HALS组与OS组组间手术及术后指标相比:手术切口长度[(7.22±0.42)cm vs(22.73±1.54)cm,P0.05]、术中出血量[(569.44±249.79)mL vs(881.50±539.73)mL,P0.05]、术后肠道功能恢复时间[(2.89±0.90)d vs(3.95±0.88)d,P0.05]、术后第一次化疗时间[(11.07±3.26)d vs(13.54±3.06)d,P0.05],HALS组均少于OS组,差异有统计学意义。手术时间[(263.61±70.86)min vs(275.00±29.96)min,P0.05]、术后住院天数[(18.17±5.35)d vs(18.20±3.93)d,P0.05],HALS组与OS组差异无统计学意义。术后残留肿瘤直径1cm的患者HALS组占总数88.89%,而OS组占总数62.5%,说明HALS组比OS组有较好的肿瘤减灭效果。2两组患者术后病理结果按组织学类型分为浆液性肿瘤、粘液性肿瘤、子宫内膜样肿瘤、透明细胞肿瘤、其他类型肿瘤,HALS组占总数比例依次为66.66%、11.11%、5.56%、0、16.67%;OS组占总数比例依次为60%、17.5%、7.5%、10%、5%。按病理分期分为I期、II期、III期、IV期,HALS组各期别依次占总数比例为0、0、77.78%、22.22%;OS组各期别依次占总数比例为15%、5%、62.5%、17.5%。3自2014年11月随访患者至2016年11月,HALS组与OS组患者的术后短期生存率差异无统计学意义。结论:1与开腹卵巢癌肿瘤细胞减灭术相比,手助腹腔镜手术没有降低治疗效果,并且具有安全可行、创伤小、恢复快、肿瘤细胞减灭程度满意的优势,值得在临床中推广应用。2早期卵巢癌可在腹腔镜下行肿瘤细胞减灭术,大部分晚期卵巢癌可借助手助腹腔镜技术完成满意的肿瘤细胞减灭术,小部分可先进行新辅助化疗再行肿瘤细胞减灭术,术后结合敏感化疗药物的应用,改善患者的预后。
[Abstract]:Objective: with the rapid development of medical technology, the treatment of gynecological malignant tumors gradually developed from traditional open surgery to minimally invasive surgery, and for a specific operation in patients with ovarian cancer has been the focus of gynecological clinicians discussed, especially for multiple organ metastasis, peritoneal adhesion in advanced ovarian cancer patients, with only "the laparoscopic technique is far from independence to achieve satisfactory cytoreduction surgery. This study explores a" hybrid "of hand assisted laparoscopic surgery (hand-assisted laparoscopic surgery, HALS) and the clinical application of reduction in ovarian cancer cells; and with the conventional laparotomy (open surgery OS) destroy the clinical application of clinical preliminary comparative study on reduction in ovarian cancer cells, to provide new ideas for clinical treatment of ovarian cancer. Methods: 1 cases collected: collected from 2014 From November to November 2016 for 58 cases of ovarian cancer tumor cells by cytoreductive surgery patients in our hospital, including hand assisted laparoscopic group (HALS group, 18 cases) and laparotomy group (group OS, 40 cases). Preoperative chemotherapy history, postoperative paraffin results belong to malignant ovarian epithelial tumor. All cases were according to the International Federation of gynecology and Obstetrics (International Federation of Gynecology and Obstetrics, FIGO 2014) surgical staging, and received TP chemotherapy.2 standard data were compared between the two groups: HALS group and OS group were age (58.33 + 8.19) [VS (55.95 + 7.29) P0.05], two years old. Patients with comorbidities including hypertension, diabetes, obesity, hypoproteinemia, abdominal surgery history, generally no significant difference, comparable.3 preoperative preparation, anesthesia and surgical posture,.4 observation index: the incision length, operative time, intraoperative bleeding 閲，

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