腹腔镜根治性子宫切除术与开腹手术治疗宫颈癌的疗效比较

发布时间：2018-11-28 08:11

【摘要】：目的比较腹腔镜下根治性子宫切除术（laparoscopic radicalhysterectomy，LRH）与经腹根治性子宫切除术（radical abdominalhysterectomy，RAH）治疗宫颈癌的疗效，探讨腹腔镜下根治性子宫切除术治疗宫颈癌的优越性、安全性及可行性。方法回顾性分析2012年1月至2013年7月重庆医科大学附属第一医院行LRH的63例宫颈癌患者的病历资料（腹腔镜组），，抽取同期行RAH的74例宫颈癌病例作为对照（开腹组）。比较两组患者的年龄、分期、组织类型、手术时间、术中出血量、术中切除淋巴结数目、术中切除阴道长度、切除主韧带长度、切除骶韧带长度、输血例数、术中及术后并发症（包括术中血管损伤、肠道损伤、输尿管损伤、膀胱损伤，术后尿路感染、尿储留、淋巴囊肿、切口感染、切口愈合不良、肠根阻）、手术预后等。结果两组的手术时间、切除淋巴结数目、切除主骶韧带长度、尿路感染例数相比较差异无统计学意义（P0.05）。腹腔镜组术中出血量明显少于开腹组（P 0.01），腹腔镜组切除的阴道长度（3.34±0.45）cm大于开腹组的（3.17±0.36）cm，P 0.05，腹腔镜组无输血患者，与开腹组比较差异有统计学意义（P 0.05）。腹腔镜组术中及术后并发症发生共13例，开腹组41例，两组差异有统计学意义（P 0.05），腹腔镜组无一例发生切口感染、切口二期缝合，与开腹组比较，两组差异有统计学意义（P 0.05），腹腔镜组仅有1例膀胱损伤，两组尿潴留、血管损伤、膀胱损伤、输尿管损伤、肠道损伤、神经损伤、肠根阻、下肢深静脉血栓淋巴囊肿比较差异无统计学意义（P0.05）。结论腹腔镜下根治性子宫切除术较开腹手术具有手术视野清晰、创伤小，手术安全性高，出血量少，手术彻底，术后恢复快等优点，对于手术治疗宫颈癌具有重要的临床应用价值。
[Abstract]:Objective to compare the efficacy of laparoscopic radical hysterectomy (laparoscopic radicalhysterectomy,LRH) and transabdominal radical hysterectomy (radical abdominalhysterectomy,RAH) in the treatment of cervical cancer. Safety and feasibility. Methods from January 2012 to July 2013, the medical records of 63 patients with cervical cancer who were treated with LRH in the first affiliated Hospital of Chongqing Medical University (laparoscopic group) were analyzed retrospectively. 74 cases of cervical cancer treated with RAH were selected as control group (open group). Age, stage, histological type, operative time, intraoperative bleeding, number of lymph nodes removed, length of vagina, length of main ligament, length of sacral ligament, blood transfusion were compared between the two groups. Intraoperative and postoperative complications (including intraoperative vascular injury, intestinal injury, ureteral injury, bladder injury, postoperative urinary tract infection, urinary retention, lymphocyst, incision infection, wound healing, intestinal root obstruction), surgical prognosis, etc. Results there was no significant difference in the operation time, the number of lymph nodes, the length of sacral ligament and the number of urinary tract infection between the two groups (P0.05). The volume of intraoperative bleeding in the laparoscopic group was significantly lower than that in the open group (P0.01), and the vaginal length in the laparoscopic group was (3.34 卤0.45) cm larger than that in the laparotomy group (3.17 卤0.36) cm,P 0.05.There was no blood transfusion in the laparoscopic group. There was significant difference between the two groups (P 0.05). There were 13 cases of intraoperative and postoperative complications in the laparoscopic group and 41 cases in the open group (P 0.05). The difference between the two groups was statistically significant (P 0.05). There was only one case of bladder injury in the laparoscopic group. Urinary retention, vascular injury, bladder injury, ureteral injury, intestinal injury, nerve injury, intestinal root obstruction were observed in the two groups. There was no significant difference in lower extremity deep vein thrombosis lymphocysts (P0.05). Conclusion Laparoscopic radical hysterectomy has the advantages of clear visual field, less trauma, high safety, less bleeding, thorough operation and quick postoperative recovery. It has important clinical application value for surgical treatment of cervical cancer.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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