子宫肿瘤及早期宫颈癌腹腔镜手术近、远期疗效的临床医学研究

发布时间：2018-03-25 23:07

本文选题：子宫良性肿瘤　切入点：腹腔镜子宫切除术　出处：《广西医科大学》2014年博士论文

【摘要】：子宫良性肿瘤腹腔镜子宫切除术后近、远期疗效的临床研究目的：比较腹腔镜全子宫切除术(LH)与开腹全子宫切除术(AH)治疗子宫良性肿瘤的近、远期疗效。方法：回顾性分析2007-2011年广西壮族自治区23家三甲医院收治的3895例子宫良性肿瘤患者临床资料，其中LH组2539例，AH组1356例。比较两种术式的手术时间、术中出血量、术中并发症、术后并发症、术后肛门排气时间、术后尿管留置时间、术后镇痛剂使用、术后住院天数、术后半年问卷随访患者的盆底及性功能情况。结果：LH与AH相比，术中出血量少、术中术后并发症少、术后疼痛少、术后肛门排气快、术后留置尿管时间短、术后住院时间短、术后半年发生排便异常（便秘）少以及发生性功能障碍少。两组之间统计学有显著性差异（P＜0.05）；而手术时间和术后发生尿失禁比较，，两组之间统计学无显著性差异(P＞0.05)。结论：现有研究结果表明，腹腔镜全宫切除术治疗子宫良性肿瘤是一种安全有效、能改善患者术后远期生活质量的手术方法，需要更多的设计良好、多中心随机对照研究进一步验证术后远期生活质量。腹腔镜子宫切除术治疗妇科良性疾病的循证医学研究目的：系统评价腹腔镜子宫切除术治疗妇科良性疾病的有效性及安全性。方法：计算机检索CENTRAL（Cochrane图书馆2013年第11期）、MEDLINE、EMBASE、CNKI、Wan Fang、VIP、CBM数据库，检索时间从建库截止2013年11月，并手工检索相关未发表的灰色文献，查找腹腔镜与开腹子宫切除术比较治疗妇科良性疾病的随机对照试验。由2位研究者按照纳入排除标准筛选文献、评价质量并提取资料后，采用RevMan5.1软件进行Meta分析。结果：纳入26个随机对照试验，共3069例患者。Meta分析结果显示：与开腹组相比，腹腔镜组具有住院时间短，术后恢复正常活动的时间短,术后血红蛋白变化值少，术后次要并发症发生率低，术后疼痛评分值低的优势，同时具有术中泌尿道损伤发生率高，术后主要远期并发症发生率高及手术时间延长的劣势。结论：现有研究显示，腹腔镜子宫切除术治疗妇科良性疾病在缩短住院时间及术后恢复正常活动时间，降低术后血红蛋白变化值、术后疼痛评分值及术后次要并发症发生率优于传统开腹手术，但缺乏术后长期生活质量结局指标的结果，期待更多高质量的随机对照试验以提供更高质量的证据。 1985-2011年广西妇科恶性肿瘤住院患者流行病学调查分析目的：了解广西区近27年间妇科恶性肿瘤住院患者的构成特点及变化趋势。方法对1985-2011年度广西区23家三甲医院收治的16123例妇科恶性肿瘤患者的临床资料进行统计分析。结果：(1)顺位及构成比：顺位排在前4位的分别是宫颈癌、卵巢恶性肿瘤、子宫内膜癌、妊娠滋养细胞肿瘤。宫颈癌的构成比呈上升的趋势，从1985-1989年度的17.48%上升到至2010-2011年度的56.74%，两者比较统计学有显著性差异（P＜0.01）；妊娠滋养细胞肿瘤呈下降的趋势，从30.69%下降到1.75%，两者比较统计学有显著性差异（P＜0.01）；而卵巢恶性肿瘤、子宫内膜癌、外阴阴道恶性肿瘤、子宫肉瘤等，比较统计学无显著性差异（P＞0.05）。(2)好发年龄：宫颈癌的好发年龄从≥60岁前移至＜40岁，呈年轻化态势；子宫内膜癌＜60岁的各年龄段患者构成比有所上升，也存在年轻化态势；卵巢恶性肿瘤及妊娠滋养细胞肿瘤患者的好发年龄无明显改变。（3）地域和职业分布：卵巢恶性肿瘤和子宫内膜癌等其他妇科恶性肿瘤发病地域城镇高于农村，而妊娠滋养细胞肿瘤农村高于城镇；前10年宫颈癌患者主要集中于城镇，构成比67.1%，后10年却主要集中在农村，构成比52.6%。(4)手术病理分期或临床分期：宫颈癌、子宫内膜癌、外阴阴道恶性肿瘤、子宫肉瘤和输卵管癌大部分为早期患者（I-II期），分别占66.3%、67.3%、51.4%、73.7%及67.9%；而卵巢恶性肿瘤及妊娠滋养细胞肿瘤多数为中晚期（III-IV期）患者，分别占56.2%及53.1%。结论：（1）应重点加强对宫颈癌的普查防治工作，同时也要加大对其他妇科肿瘤的防治力度。（2）加大对卵巢恶性肿瘤及妊娠滋养细胞肿瘤相应肿瘤标志物、新的诊治方法的发现和研究力度，提高早期诊治率。子宫内膜癌腹腔镜手术治疗近、远期疗效的临床研究目的：比较腹腔镜与开腹手术治疗子宫内膜癌的近、远期疗效，并探讨患者的预后影响因素。方法：回顾性分析2007-2011年广西壮族自治区6家三甲医院收治的567例子宫内膜癌患者临床资料，按术式的不同分为腹腔镜组266例，开腹组301例，比较两种术式的手术时间、术中出血量、术中并发症、术后并发症、术后肛门排气时间、术后尿管留置时间、术中淋巴结切除数目、术后住院天数、术后半年盆底功能障碍、术后半年性功能障碍、复发率、无瘤生存率及总生存率。采用Kaplan-Meier法描绘生存曲线、计算生存率，生存分析的检验采用Log-rank检验；对可能影响子宫内膜癌预后的因素采用Cox回归模型进行单因素及多因素分析。结果：腹腔镜组与开腹组相比，手术时间延长、术中失血量少、术后肠道功能恢复快、留置尿管时间短、术后住院天数减少、术后尿潴留发生少以及术后腹部伤口愈合不良发生少，两组之间统计学有显著性差异（P＜0.05）。术中淋巴结切除数目、术中并发症总例数、术后并发症总例数、术后半年盆底功能障碍、术后半年性功能障碍、复发率、无瘤生存率和总生存率，两组相比较均无显著性差异(P＞0.05)。单因素及多因素分析示病理类型和手术病理分期是独立的预后因素。结论：腹腔镜手术治疗子宫内膜癌具有和开腹手术相似的术后远期生活质量及肿瘤生存预后，是一种较为安全有效的治疗方法。需要更多的设计良好、多中心、前瞻性随机对照研究长期随访，进一步验证腹腔镜治疗的术后远期生活质量和生存预后。子宫内膜癌腹腔镜手术治疗的循证医学研究目的：系统评价子宫内膜癌腹腔镜手术治疗的有效性及安全性。方法：计算机检索CENTRAL（Cochrane图书馆2013年第11期）、MEDLINE, EMBASE,PUBMED, CNKI、Wan Fang、VIP、CBM数据库，检索时间从建库截止2013年11月，并手工检索相关未发表的灰色文献，查找比较腹腔镜与开腹手术治疗子宫内膜癌的随机对照试验。由2位研究者按照纳入排除标准筛选文献、评价质量并提取资料后，采用RevMan5.1软件进行Meta分析。结果：纳入9个随机对照试验，共3616例子宫内膜癌患者。Meta分析结果显示：与开腹组相比，腹腔镜组具有缩短住院时间及降低术后并发症的优势，同时具有手术时间延长，增加术中并发症的劣势，两组在3年总生存率、3年无瘤生存率、3年复发率及盆腔淋巴结切除数目方面，其差异均无统计学意义(P＞0.05)。结论：现有研究显示，腹腔镜手术治疗子宫内膜癌在缩短住院时间及减少术后并发症方面优于开腹手术，但缺乏术后长期结局指标特别是生活质量的评价结果，期待更多高质量的随机对照试验以提供更高质量的证据。早期宫颈癌腹腔镜治疗近、远期疗效的临床研究目的：比较腹腔镜与开腹手术治疗早期宫颈癌的近、远期疗效，并探讨患者的预后影响因素。方法：回顾性分析2007-2011年广西壮族自治区6家三甲医院收治的1091例临床分期IA1-IIB期宫颈癌患者的临床资料，按术式不同分为腹腔镜组455例，开腹组636例，比较两种术式的手术时间、术中出血量、术中并发症、术后并发症、术后肛门排气时间、术后尿管留置时间、术中淋巴结切除数目、术中左右宫旁和阴道组织切除长度、术后住院天数、术后半年盆底功能障碍、术后半年性功能障碍、复发率、无瘤生存率及总生存率。采用Kaplan-Meier法描绘生存曲线、计算生存率，生存分析的检验采用Log-rank检验；对可能影响宫颈癌预后的因素采用Cox回归模型进行单因素及多因素分析。结果：腹腔镜组与开腹组相比手术时间长，但术中失血量少、术后肠道功能恢复快、留置尿管时间短、术后住院天数减少、术后并发症发生少、术后腹部伤口愈合不良发生少、术中宫旁和阴道组织切除长度多、术后尿失禁发生少及术后性功能障碍发生少，两组之间统计学有显著性差异（P＜0.05）。术中淋巴结切除数目、术中并发症总例数、术后发生排便异常、复发率、无瘤生存率和总生存率，两组相比均无显著性差异(P＞0.05)。单因素及多因素分析示宫颈间质侵润深度和淋巴结状态是独立的预后因素。结论：腹腔镜手术治疗早期宫颈癌能改善患者术后远期生活质量，具有和开腹手术相似的肿瘤生存预后，是一种较为安全有效的治疗方法。需要更多的设计良好、多中心、前瞻性随机对照研究进一步验证腹腔镜治疗的术后远期生活质量和生存预后。早期宫颈癌腹腔镜手术治疗的循证医学研究目的：系统评价早期宫颈癌腹腔镜手术治疗的有效性及安全性。方法：计算机检索CENTRAL（Cochrane图书馆2013年第11期）、MEDLINE, EMBASE,PUBMED, CNKI、Wan Fang、VIP、CBM数据库，检索时间从建库截止2013年11月，并手工检索相关未发表的灰色文献，查找比较腹腔镜与开腹手术治疗早期宫颈癌的随机对照试验（RCTs）和对照临床试验（CCTs）。由2位研究者按照纳入排除标准筛选文献、评价质量并提取资料后，采用RevMan5.1软件进行Meta分析。结果：纳入1个随机对照试验（RCT）和5个对照临床试验(CCTs)，共322例早期宫颈癌患者。Meta分析结果显示：与开腹手术相比，腹腔镜手术具有缩短住院时间及减少术中出血量的优势，同时具有手术时间延长的劣势，两组在3年总生存率、3年复发率、术中术后并发症及盆腔淋巴结切除数目方面，其差异均无统计学意义(P＞0.05)。结论：现有研究显示，腹腔镜手术治疗早期宫颈癌在缩短住院时间及减少术中出血方面优于开腹手术，但缺乏术后长期结局指标特别是生活质量的评价结果，期待更多高质量的随机对照试验以提供高质量的证据。
[Abstract]:A clinical study on the long-term effect of laparoscopic hysterectomy for benign uterine tumors
Objective: To compare the near and long-term effect of laparoscopic total hysterectomy (LH) and open hysterectomy (AH) for the treatment of benign uterine tumors.
Methods: a retrospective analysis of 2007-2011 the Guangxi Zhuang Autonomous Region 23 hospitals treated 3895 cases of benign uterine tumors in patients with clinical data, including 2539 cases of LH group, AH group of 1356 cases. The two groups were compared operative time, intraoperative blood loss, intraoperative complications, postoperative complications, postoperative anal exhaust time, indwelling catheter the postoperative time, postoperative analgesic use, postoperative hospital stay, pelvic floor and sexual function questionnaire for half a year follow-up of patients after the surgery.
Results: LH compared with AH, less bleeding, less postoperative complications, less postoperative pain, postoperative exhaust fast, postoperative indwelling catheter time, postoperative hospitalization time is short, half a year after operation occurred abnormal defecation (constipation) and sexual dysfunction between the two groups. There was statistically significant difference (P < 0.05); and compare the operation time and postoperative urinary incontinence, no statistically significant difference between the two groups (P > 0.05).
Conclusion: the present results suggest that laparoscopic hysterectomy for uterine benign tumor is a safe and effective, can improve the postoperative quality of life in long-term operation method, the need for more well-designed, multicenter randomized controlled study to further verify the long-term postoperative quality of life.
The evidence-based medicine study of laparoscopic hysterectomy for benign gynecologic diseases
Objective: To evaluate the efficacy and safety of laparoscopic hysterectomy in the treatment of benign gynecologic diseases.
Methods: We searched CENTRAL (Cochrane Library in 2013 eleventh), MEDLINE, EMBASE, CNKI, Wan, Fang, VIP, CBM database, retrieved from the database by the end of November 2013, and a hand search of grey literature relevant unpublished, find the laparoscopic and open resection of uterine surgery for randomized controlled trials of benign gynecologic diseases by 2. The researchers screened the literature according to the inclusion and exclusion criteria, quality assessment and data extraction, Meta analysis was carried out by RevMan5.1 software.
Results: a total of 26 randomized controlled trials, a total of 3069 cases of.Meta patients compared with the laparotomy group, laparoscopic group has shorter hospitalization time, postoperative recovery time, postoperative hemoglobin change value less postoperative secondary low complication rate, postoperative pain score low advantage, at the same time intraoperative urinary tract injury with high incidence of major postoperative complications, prolong operation time and high rate of disadvantage.
Conclusion: the present study shows that laparoscopic hysterectomy for treatment of gynecological benign diseases in the normal activity time shorten the hospitalization time and postoperative hemoglobin change decreased after operation, postoperative pain score and postoperative secondary complications than traditional open surgery, but the lack of long-term life quality of postoperative outcome results, expect more randomized controlled trials of high quality to provide high quality evidence.
Epidemiological investigation and analysis of hospitalized patients with gynecologic malignant tumors in Guangxi in the past 1985-2011 years
Objective: to understand the composition and trend of the hospitalized patients with gynecologic malignant tumors in Guangxi in the last 27 years.
Methods the clinical data of 16123 patients with gynecologic malignancies in 23 third class hospitals in Guangxi District in 1985-2011 were analyzed.
Results: (1) the sequence and proportion of cis position: in the top 4 were cervical cancer, ovarian cancer, endometrial cancer, gestational trophoblastic tumor. Cervical cancer than a rising trend, from the year 1985-1989 rose to 17.48% to 2010-2011 year 56.74%, two comparison statistics there was significant difference (P < 0.01); gestational trophoblastic tumor decreased, decreased from 30.69% to 1.75%, two groups have statistically significant difference (P < 0.01); and ovarian cancer, endometrial cancer, vulvovaginal malignant tumor, sarcoma of uterus, compared with no statistically significant difference (P > 0.05). (2) good age: cervical cancer diagnosed at the age of over 60 years from the forward to the < 40 years old, had a younger trend; endometrial carcinoma under 60 years of age with constituent ratio increased, there are also young situation; ovarian malignant tumor and pregnancy. A cell tumor patients good age had no obvious change. (3) region and occupation distribution: ovarian cancer and endometrial cancer and other gynecological malignant tumor incidence area of urban higher than rural, and gestational trophoblastic tumor in rural areas than in towns; 10 years ago the cervical cancer patients were mainly concentrated in the town, after accounting for 67.1%. The 10 year is mainly concentrated in rural areas, accounting for 52.6%. (4): surgical pathological or clinical staging of cervical cancer, endometrial cancer, vulvovaginal malignant tumor, sarcoma of uterus and fallopian tube cancer most patients in the early stage (stage I-II), accounted for 66.3%, 67.3%, 51.4%, 73.7% and 67.9%; and malignant ovarian tumor and the majority of gestational trophoblastic tumor in advanced stage (stage III-IV) were respectively 56.2% and 53.1%.
Conclusion: (1) should focus on strengthening the work of the census on prevention and treatment of cervical cancer, but also to increase the other gynecological cancer prevention efforts. (2) increase of ovarian malignant tumor and gestational trophoblastic tumor with corresponding tumor markers, and found the new methods for the diagnosis and treatment of research efforts, improve the early diagnosis rate.
Clinical study on the long-term effect of laparoscopic surgery for endometrial carcinoma
Objective: To compare the near and long term effects of laparoscopy and laparotomy in the treatment of endometrial carcinoma, and to explore the prognostic factors of the patients.
Methods: a retrospective analysis of 2007-2011 the Guangxi Zhuang Autonomous Region 6 hospitals treated 567 cases of endometrial cancer patients with clinical data, according to the different operation for 266 cases of laparoscopic group, 301 cases in the laparotomy group, the two groups were compared operative time, intraoperative blood loss, intraoperative complications, postoperative complications, anal the postoperative exhaust time, postoperative catheter indwelling time, the number of lymph nodes removed during surgery, postoperative hospital stay, postoperative half year pelvic floor dysfunction, sexual dysfunction, the rate of postoperative recurrence, disease-free survival and overall survival rate. Survival curve was calculated by using Kaplan-Meier method to calculate the survival rate, survival analysis using Log-rank test inspection; on the factors that may affect the prognosis of endometrial cancer Cox regression model was used for univariate and multivariate analysis.
Results: compared with the laparoscopic group and laparotomy group. The operation time, intraoperative blood loss, postoperative intestinal function recovery time, indwelling catheter time, postoperative hospitalization days reduced, postoperative urinary retention and less postoperative abdominal wound healing occurred less, there was significant difference statistically between the two groups (P < 0.05). The number of lymph nodes removed during surgery, intraoperative complications, postoperative complications, the total number of cases, the first half of half a year after the operation of pelvic floor dysfunction, sexual dysfunction, the rate of postoperative recurrence, disease-free survival and overall survival rate, compared with the two groups showed no significant difference (P > 0.05). Univariate and multivariate analysis showed that pathological type and surgical pathological staging were independent prognostic factors.
Conclusion: laparoscopic surgery in the treatment of endometrial cancer with open surgery and similar long-term postoperative life quality and prognosis of tumor, is a safe and effective therapeutic method. The need for more well-designed, multicenter, long-term follow-up of a prospective randomized controlled study, further validation of laparoscopic treatment of postoperative and long-term quality of life the prognosis.
Evidence-based medicine study of laparoscopic surgery for endometrial carcinoma
Objective: To evaluate the efficacy and safety of laparoscopic surgery for endometrial carcinoma.
Methods: We searched CENTRAL (Cochrane Library in 2013 eleventh), MEDLINE, EMBASE, PUBMED, CNKI, Wan, Fang, VIP, CBM database, retrieved from the database by the end of November 2013, and a hand search of grey literature relevant unpublished, randomized controlled trials for comparison of laparoscopic and open surgery in the treatment of endometrial cancer by 2. The researchers screened the literature according to the inclusion and exclusion criteria, quality assessment and data extraction, Meta analysis was carried out by RevMan5.1 software.
Results: a total of 9 randomized controlled trials, a total of 3616 cases of.Meta patients with endometrial cancer compared with the laparotomy group, laparoscopic group can shorten the hospitalization time and reduce the advantage of postoperative complications, and has prolonged the operative time, intraoperative complications increased disadvantage, two groups in the 3 year overall survival rate for 3 years. 3 years disease-free survival rate, recurrence rate and pelvic lymphadenectomy number, the differences were not statistically significant (P > 0.05).
Conclusion: the present study shows that laparoscopic surgery in treatment of endometrial cancer to shorten the hospitalization time and reduce postoperative complications than open surgery, but the lack of long-term postoperative outcomes especially life quality evaluation results, look forward to more high quality randomized controlled trials to provide high quality evidence.
Clinical study of early laparoscopic treatment for early cervical cancer
Objective: To compare the near and long term effects of laparoscopy and laparotomy in the treatment of early cervical cancer, and to explore the prognostic factors of the patients.
Methods: a retrospective analysis of the clinical data of 1091 cases of 2007-2011 years from 6 tertiary hospitals in the Guangxi Zhuang Autonomous Region were stage IA1-IIB cervical cancer patients, according to the different operative methods were divided into laparoscopic group 455 cases, 636 cases in the laparotomy group, the two groups were compared operative time, intraoperative blood loss, intraoperative complications, postoperative complications, postoperative anal exhaust time, postoperative catheter indwelling time, the number of lymph nodes removed during surgery, intraoperative left parametrial and vaginal tissue resection length, postoperative hospital stay, postoperative half year pelvic floor dysfunction, sexual dysfunction, the rate of postoperative recurrence, disease-free survival and overall survival. The survival curves were depicted by Kaplan-Meier method to calculate the survival rate, survival analysis test using Log-rank test; the factors that may affect the prognosis of cervical cancer Cox regression model was used for univariate and multivariate analysis.
Results: laparoscopic group and laparotomy group compared to the operation for a long time, but less intraoperative blood loss, postoperative intestinal function recovery time, indwelling catheter time, postoperative hospitalization days reduced, reducing postoperative complications, low incidence of adverse abdominal wound healing after surgery, intraoperative uterine and vaginal tissue resection length. Postoperative urinary incontinence and sexual dysfunction after operation occurred less statistically between the two groups had significant difference (P < 0.05). The number of lymph nodes removed during surgery, intraoperative complications, postoperative defecation, recurrence rate, disease-free survival rate and overall survival rate, compared to the two groups there was no significant difference (P > 0.05). Univariate and multivariate analysis showed that cervical stromal invasion depth and lymph node status were independent prognostic factors.
Conclusion: laparoscopic surgery in the treatment of early cervical cancer patients can improve the long-term postoperative quality of life, and has a laparotomy similar tumor prognosis, which is a safe and effective treatment method. The need for more well-designed, multicenter, prospective randomized study to further validate the laparoscopic treatment of postoperative and long-term quality of life the prognosis.
Evidence based study of laparoscopic surgery for early cervical cancer
Objective: To evaluate the efficacy and safety of laparoscopic surgery for early cervical cancer.
Methods: We searched CENTRAL (Cochrane Library in 2013 eleventh), MEDLINE, EMBASE, PUBMED, CNKI, Wan, Fang, VIP, CBM database, retrieved from the database by the end of November 2013, and a hand search of grey literature relevant unpublished, randomized controlled trials for comparison of laparoscopic and open surgery for early stage cervical carcinoma (RCTs) and controlled clinical trials (CCTs). By 2 researchers according to inclusion and exclusion criteria, literature screening, quality assessment and data extraction, Meta analysis was carried out by RevMan5.1 software.
Results: a total of 1 randomized controlled trials (RCT) and 5 controlled clinical trials (CCTs) were included in the study. A total of 322 patients with early cervical cancer were analyzed by.Meta. Results showed that compared with laparotomy, laparoscopic surgery has the advantage of shortening hospitalization time and reducing intraoperative blood loss, and having hand time.

【学位授予单位】：广西医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R737.33

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