局部晚期宫颈癌腹腔镜下腹膜后淋巴结切除术的疗效研究

发布时间：2019-02-18 08:36

【摘要】：目的探讨局部晚期宫颈癌行腹腔镜下腹膜后淋巴结切除术的可行性及对临床的指导意义。方法对30例经病理证实的局部晚期宫颈癌进行腹腔镜下盆腔淋巴结切除+腹主动脉旁淋巴结切除+双附件切除术。结果30例宫颈癌患者术后病理盆腔淋巴结转移18例,转移率60.0%;腹主淋巴结转移2例,转移率6.7%。共切除盆腔淋巴结1005枚,平均33.50枚;共切除腹主淋巴结305枚,平均10.17枚。手术时间1.5~3 h,平均2.0 h;出血量10~80 ml,平均42 ml;术后肠道功能恢复时间16~41 h,平均21 h;术后放疗开始时间:7~12天,平均9.4天;术后单纯淋巴囊肿4例,直径3~4 cm。放疗后出现下肢淋巴回流障碍1例;3例出现放射性直肠炎;1例行结肠造瘘;1例出现放射性膀胱炎。随访8~53个月,中位随访时间27个月,2例复发,复发率6.7%(2/30),6例死亡,死亡率20.0%(6/30),3年无瘤生存率72%,3年总体生存率75%。结论局部晚期宫颈癌患者接受腹腔镜下淋巴结切除手术安全、可行,评估淋巴结状态精确,可以弥补FIGO临床分期存在的缺陷,切除转移淋巴结的同时对宫颈癌的个体化治疗具体指导意义。
[Abstract]:Objective to investigate the feasibility and clinical significance of laparoscopic retroperitoneal lymphadenectomy for locally advanced cervical cancer. Methods 30 cases of locally advanced cervical carcinoma confirmed by pathology were treated with laparoscopic pelvic lymph node resection and double appendage resection. Results there were 18 cases of pelvic lymph node metastasis in 30 cases of cervical cancer and 2 cases of abdominal main lymph node metastasis, with a metastasis rate of 6.7%. A total of 1005 pelvic lymph nodes (mean 33.50) and a total of 305,10.17 main abdominal lymph nodes were resected. The mean time of operation was 2. 0 hours, the mean time of recovery of intestinal function was 16 ~ 41 hours (mean 21 hours) after operation for 10 ~ 80 ml, and 42 ml;, the beginning time of postoperative radiotherapy was 7 ~ 12 days with an average of 9. 4 days. Postoperative simple lymphoid cyst: 4 cases, 3 cm. in diameter There were 1 case of lymphatic reflux disorder of lower extremity after radiotherapy, 3 cases of radioactive proctitis, 1 case of colostomy and 1 case of radioactive cystitis. The median follow-up time was 27 months. The recurrence rate was 6.7% (2 / 30), 6 cases died, the mortality rate was 20.0% (6 / 30), the 3-year tumor-free survival rate was 72%, and the overall 3-year survival rate was 75%. Conclusion Laparoscopic lymphadenectomy in patients with locally advanced cervical cancer is safe, feasible and accurate in evaluating lymph node status, which can make up for the defects in clinical staging of FIGO. Excision of metastatic lymph nodes at the same time for the individual treatment of cervical cancer specific guiding significance.
【作者单位】：江西省妇幼保健院;遂川县妇幼保健院;
【分类号】：R737.33

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