腹腔镜下腹膜后淋巴结清扫术在局部中晚期宫颈癌患者中的循证医学与临床研究

发布时间：2018-04-27 20:13

本文选题：腹腔镜 + 腹膜后淋巴结清扫术　；参考：《广西医科大学》2014年硕士论文

【摘要】：宫颈癌是发展中国家常见的恶性肿瘤之一,据WHO统计,80%的新发病例都发生在发展中国家,其中的80%是中晚期患者。目前妇科肿瘤中卵巢癌和子宫内膜癌均已采用病理分期,宫颈癌仍使用FIGO临床分期,并未考虑淋巴结对预后的影响,很多临床分期与手术分期的差异被报道。腹腔镜具有放大,视野清晰,容易辨别解剖位置等特点。随着腹腔镜技术的普及,腹腔镜下手术病理分期的有效性和安全性得到了肯定。在手术方式的选择上,1996年首次开展腹腔镜下腹膜外淋巴结清扫术,它同时结合了腹腔镜和腹膜外路径的优点,直接降低了肠道损伤、肠道粘连的风险并降低住院治疗的时间,对提高患者的生活质量带来极大的帮助。国外的妇瘤专家不断对此技术进行改良,并对腹腔镜下腹膜后入路的可行性和安全性进行探讨。国内研究较少。本研究分为二部分：1、腹腔镜下腹膜后淋巴结清扫术在局部中晚期宫颈癌患者中可行性和安全性的系统评价。2、腹腔镜下腹膜后淋巴结清扫术在局部中晚期宫颈癌患者中的初步临床研究。临床数据均来自广西医科大学附属肿瘤医院妇瘤科。目的进行系统的文献回顾对于腹腔镜下腹膜后淋巴结清扫术对局部中晚期宫颈癌患者的治疗提供了现有文献的循证医学证据。方法检索CBM、 CENTRAL、MEDLINE、Cochrane library、EMBASE、CNKI数据库中关于腹腔镜下腹膜后淋巴结清扫术(Laparoscopic retroperitoneal lymph node dissection LRLD)治疗局部中晚期宫颈癌(locally advanced cervical cancer LACC)患者的临床资料,进行相关文献分析,探讨LRLD应用于LACC患者的安全性、可行性及临床意义。结果12项研究符合纳入标准,RCT研究2项,描述性研究10篇。宫颈癌亚组共入组727例病例,腹膜后组695例,经腹膜组32例。从手术过程,手术效果,术后短期恢复情况,术后复发及长期预后等方面,对腹腔镜下腹膜后淋巴结清扫术治疗局部中晚期宫颈癌的可行性进行评估与探讨。为腹腔镜下腹膜后淋巴结清扫术对局部中晚期宫颈癌患者的治疗提供了有利的循证医学证据。结论目前腹腔镜下腹膜后淋巴结清扫术手术切口小、术后肠道功能恢复快、饮食恢复快、住院时间短等优点已基本得到认可。但由于仍欠缺大规模病例的多中心RCT研究,局部及远处复发率以及长期预后包括5年生存期等仍欠缺大规模病例的多中心RCT研究。目的探讨腹腔镜下腹膜后淋巴结清扫术(Laparoscopic retroperitoneal lymph node dissection LRLD)应用在局部中晚期宫颈癌患者中的技术要点、可行性及其安全性。方法对广西医科大学附属肿瘤医院2013年03月至2014年03月收治的13例经病理证实的局部中晚期(IIB-IVA)宫颈癌患者进行腹腔镜下经腹膜外淋巴结清扫。对所得数据进行可行性分析。结果1例手术在分离过程中腹膜破裂,C02气体进入腹腔内,无法维持腹膜外腔压力,改腹膜内手术,余12例腹腔镜下腹膜外淋巴结清扫术成功,手术治疗的中位时间为230分钟(130-359分钟),术中出血量中位数50(20-350)m1。淋巴结取出总数为336个,10(5-17)个腹主动脉旁淋巴结,和18(16-40)个盆腔淋巴结。11(91.7%)患者淋巴结转移。并发症为术后淋巴囊肿的形成,在充分引流后淋巴囊肿消失体温降至正常,随访1-12个月,无复发及转移病例。结论LRLD术式在技术上是安全,可行的,患者痛苦小,切口小,恢复快,缩短住院时间,减少失血量,减瘤的同时为后续放疗野的确定提供了依据,术后并发症发生率低可以使患者日常生活迅速恢复,后续辅助治疗早期开始,提高了生活质量。
[Abstract]:Cervical cancer is one of the most common malignant tumors in developing countries. According to WHO statistics, 80% of new cases occur in developing countries, and 80% of them are middle and late patients. At present, both ovarian and endometrial cancer in gynecologic tumors have been staging by pathological stages. Cervical cancer still uses FIGO clinical staging and does not consider the effect of lymph node on prognosis. The difference between clinical staging and surgical staging has been reported. Laparoscopy has the characteristics of magnification, clear vision, easy to distinguish the anatomical position. With the popularization of laparoscopy, the effectiveness and safety of the pathological stage of the laparoscopic operation are confirmed. In the choice of surgical methods, the laparoscopic inferior peritoneal lymph node dissection was first carried out in 1996. It also combines the advantages of laparoscopy and extraperitoneal route, which directly reduces the intestinal damage, the risk of intestinal adhesion and reduces the time of hospitalization. It is a great help to improve the quality of life of the patients. The foreign women's cancer experts continue to improve the technology and the feasibility and safety of the laparoscope underbelly. This study is divided into two parts. This study is divided into two parts: 1, a systematic evaluation of the feasibility and safety of laparoscopic hypogastric lymph node dissection in patients with locally advanced cervical cancer. A preliminary clinical study of laparoscopic hypogastric lymph node dissection in patients with locally advanced cervical cancer.
All the clinical data were from the Department of gynaecology and oncology, Affiliated Tumor Hospital of Guangxi Medical University.
Objective to provide a systematic literature review on the evidence of evidence-based medicine in the existing literature on the treatment of patients with locally advanced cervical cancer by laparoscopic hypogastric lymph node dissection. Methods CBM, CENTRAL, MEDLINE, Cochrane library, EMBASE, CNKI database on retroperitoneal lymph node dissection of abdominal endoscopy (Laparoscopic retr) Operitoneal lymph node dissection LRLD) in the treatment of patients with locally advanced cervical cancer (locally advanced cervical cancer LACC), the clinical data of patients with locally advanced cervical cancer LACC were analyzed, and the safety, feasibility and clinical significance of LRLD applied to LACC patients were discussed. Results 12 studies were included in the inclusion criteria, 2 studies, 10 descriptive studies. 727 cases, 695 Cases of retroperitoneal group and 32 cases of peritoneum group were included in the cancer subgroup. The feasibility of laparoscopic Subperitoneal lymphadenectomy for the treatment of locally advanced cervical cancer was evaluated and discussed from the operation process, the operation effect, the postoperative short-term recovery, the postoperative recurrence and the long-term prognosis. It provides evidence of evidence-based medicine for the treatment of locally advanced cervical cancer. Conclusion the advantages of small incision, quick recovery of postoperative intestinal function, quick recovery of diet, short stay in hospital have been basically recognized by laparoscopic underbelly lymph node dissection, but there is still a lack of multicenter RCT study for large cases. Local and distant recurrence rates and long-term prognosis, including 5 year survival, are still lacking in large scale multicenter RCT studies.
Objective to investigate the technical points, feasibility and safety of the application of Laparoscopic retroperitoneal lymph node dissection LRLD (lymph node dissection LRLD) in patients with locally advanced cervical cancer. Methods 13 cases confirmed by pathology from 03 months to 03 months in the Cancer Hospital Affiliated to Guangxi Medical University were confirmed by pathology. 1 patients with advanced (IIB-IVA) cervical cancer underwent laparoscopic extraperitoneal lymph node dissection. Results the results of the data were analyzed. Results 1 cases were broken through peritoneum during the process of separation, C02 gas entered the abdominal cavity, the extraperitoneal pressure could not be maintained, peritoneal surgery was changed, and the remaining 12 cases of laparoscopic inferior abdominal lymph node dissection were successful. The median time of the operation was 230 minutes (130-359 minutes), the median 50 (20-350) m1. lymph nodes were removed, 10 (5-17) para aortic lymph nodes, and 18 (16-40) pelvic lymph nodes.11 (91.7%) lymph node metastasis. The complication was the formation of postoperative lymphatic cysts and the disappearance of lymphatic cysts after full drainage. The LRLD operation was technically safe, feasible, small pain, small incision, quick recovery, shorter hospital stay, less blood loss, reduction of blood loss, and a basis for the determination of subsequent radiotherapy field. The low incidence of postoperative complications could quickly restore the patient's daily life. In addition, subsequent adjuvant treatment started early and improved the quality of life.

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

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