腹腔镜下腹主动脉旁淋巴结切除在子宫内膜癌诊治中的临床研究

发布时间：2018-04-23 22:40

本文选题：子宫内膜癌 + 腹主动脉旁淋巴结切除术　；参考：《实用妇产科杂志》2015年03期

【摘要】：目的:探讨腹腔镜下腹主动脉旁淋巴结切除在子宫内膜癌诊治中的应用价值及安全性、可行性。方法:选择2010年3月至2014年3月子宫内膜癌患者89例,其中,行腹腔镜下腹主动脉旁淋巴结切除手术50例(腹腔镜组),传统开腹腹主动脉旁淋巴结切除手术39例(开腹组),比较两组围手术期情况、术中及术后并发症、预后,统计分析淋巴结转移患者临床病理特征。结果:腹腔镜组和开腹组患者在切除的淋巴结数目上差异无统计学意义(P0.05),腹腔镜组较开腹组腹主动脉旁淋巴结切除出血量少、术后病率低、术后肛门排气时间早、术后住院时间短,但切除腹主动脉旁淋巴结时间长于开腹组,两组比较差异均有统计学意义(P0.01,P0.05)。腹腔镜组与开腹组在术中腔静脉损伤、术后尿潴留、淋巴囊肿、深静脉血栓、肺动脉栓塞发生率比较,差异无统计学意义(P0.05),而开腹组切口裂开4例,腹腔镜组无切口裂开,两组比较差异有统计学意义(P0.05)。术后发现盆腔和(或)腹主动脉旁淋巴结转移共8例,除术前1例患者发现脐部癌转移诊断为ⅣB期和1例患者磁共振成像提示盆腔淋巴结肿大癌转移诊断ⅢC1期与术后病理诊断相同外,其余6例分期均较术前升高。两组术后随访:开腹组复发2例,其中1例死亡;腹腔镜组复发1例后死亡,均为晚期子宫内膜癌患者。结论:腹主动脉旁淋巴结切除是子宫内膜癌规范化诊治的重要组成部分,在对子宫内膜癌患者准确分期、制定精确术后诊治方案,改善预后方面作用是肯定的,腹腔镜下腹主动脉旁淋巴结切除手术安全可行,优于传统开腹手术。
[Abstract]:Objective: To investigate the value and safety of laparoscopic inferior abdominal aortic lymph node resection in the diagnosis and treatment of endometrial carcinoma. Methods: 89 patients with endometrial carcinoma from March 2010 to March 2014 were selected, including 50 cases of laparoscopic inferior abdominal aortic lymph node resection (laparoscopy group) and traditional open abdominal aorta lymph nodes. 39 cases (open group), compared two groups of perioperative conditions, intraoperative and postoperative complications, prognosis, statistical analysis of the clinicopathological features of patients with lymph node metastasis. Results: there was no significant difference in the number of lymph nodes in the laparoscopic group and the open group (P0.05), and the laparoscopic group was compared with the open abdominal aorta lymph node excision. Less bleeding, low postoperative morbidity, early postoperative anus exhaust time and short hospital stay, but the time for the resection of the para aortic lymph nodes was longer than that in the open group. The two groups were statistically significant (P0.01, P0.05). The laparoscopic and open group were injured in the intraoperative vena cava, postoperative urinary retention, lymphatic cysts, deep venous thrombosis, pulmonary embolism. There was no significant difference in the rate of birth (P0.05), but in the open group, 4 cases were split, and the two groups had no significant difference (P0.05). There were 8 cases of pelvic and / or abdominal lymph node metastases in the pelvic and / or abdominal aorta after the operation. The diagnosis of the metastatic carcinoma of the umbilicus in the 1 patients before the operation was the fourth B phase and 1 patients with magnetic resonance imaging. The diagnosis of metastatic carcinoma of the pelvic lymph node with tumor metastasis was the same as that of the postoperative pathological diagnosis, the other 6 cases were higher than those before the operation. Two groups were followed up after operation: 2 cases were recurrent in the open group, 1 of them died, and 1 cases died after the laparoscopy group, all were advanced endometrium cancer patients. Conclusion: abdominal aortic lymph node resection is the normalization of endometrial carcinoma. The important part of the diagnosis and treatment is affirmative in the accurate staging of patients with endometrial cancer, the formulation of accurate postoperative diagnosis and treatment scheme, and the improvement of the prognosis. The laparoscopic inferior abdominal aortic lymph node resection is safe and feasible, which is superior to the traditional laparotomy.

【作者单位】：扬州大学附属泰兴医院;南京大学医学院附属鼓楼医院;
【基金】：江苏省卫生厅专项科研基金(编号:YG201302)
【分类号】：R737.33

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