无气腹腹腔镜与传统腹腔镜宫颈癌根治术的对比研究

发布时间：2018-02-13 17:24

本文关键词： 无气腹腹腔镜宫颈癌中老年广泛子宫切除血流动力学稳定　出处：《中国微创外科杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨无气腹腹腔镜治疗中老年宫颈癌患者的安全性及临床应用价值。方法回顾性分析2014年6月~2015年10月年龄50岁的腹腔镜宫颈癌根治术50例临床资料,其中无气腹手术24例,气腹手术26例,比较2组气腹前、术中60 min时平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、吸气峰压(peak inspiratory pressure,PIP)、呼气末CO2分压(P_(ET)CO_2),以及手术时间、术中出血量、清扫淋巴结数目、切除阴道壁长度、住院费用、肛门排气时间、术后住院时间、并发症等指标。结果无气腹组术中MAP、PIP、P_(ET)CO_2、HR与术前无统计学差异(P0.05);气腹组术中MAP、PIP、P_(ET)CO_2较术前明显升高(t=-6.669、-7.636、-4.387,P均=0.000),HR无统计学差异(t=-1.443,P=0.161)。2组手术时间、术中出血量、清扫淋巴结数、切除阴道壁长度无统计学差异(P0.05)。无气腹组肛门排气时间、术后住院时间、住院费用均明显少于气腹组[(2.0±0.6)d vs.(2.5±0.5)d,t=-2.886,P=0.006;(7.4±1.3)d vs.(8.2±1.4)d,t=-2.072,P=0.044;(2.0±0.6)万元vs.(2.5±0.5)万元,t=-3.853,P=0.000]。2组均无术中并发症发生,术后淋巴潴留囊肿分别为17%(4/24)、19%(5/26),无统计学差异(χ~2=0.000,P=1.000)。结论无气腹腹腔镜宫颈癌根治术避免气腹对人体血流动力学的影响,术中呼吸循环系统稳定,术后肠道功能恢复快,住院时间短,可达到腹腔镜宫颈癌手术同样的根治效果,中老年患者接受无气腹腹腔镜宫颈癌根治术是安全可行的。
[Abstract]:Objective to evaluate the safety and clinical value of pneumoperitoneal laparoscopy in the treatment of cervical cancer in middle-aged and elderly patients. Methods the clinical data of 50 patients with cervical cancer aged 50 years from June 2014 to October 2015 were retrospectively analyzed. There were 24 cases without pneumoperitoneum and 26 cases with pneumoperitoneum. The mean arterial pressure before pneumoperitoneum and 60 min after pneumoperitoneum were compared between the two groups. The mean arterial pressureMAPP, heart rate, peak peak inspiratory pressure, peak inspiratory pressurePIPP, end expiratory CO2 partial pressure (CO2), and the number of dissected lymph nodes were compared between the two groups before pneumoperitoneum, operation time, intraoperative blood loss and the number of lymph nodes dissected. Length of vaginal wall, cost of hospitalization, time of anal exhaust, length of stay after operation, Results in the pneumoperitoneum group, there was no significant difference in MAPPIPP / PSP and ETCO _ 2 HR between before and after pneumoperitoneum (P < 0.05), but in pneumoperitoneum group, MAPPIPP _ P _ (ETCO _ 2) was significantly higher than that before pneumoperitoneum, and there was no significant difference in blood loss and lymph node number during operation between the two groups (P = 0.000, P < 0.05, P < 0.05), and the number of lymph nodes dissected during operation in the pneumoperitoneum group (P < 0.05), but there was no significant difference between the two groups in blood loss and lymph node dissection in the pneumoperitoneum group (P < 0.05). There was no significant difference in the length of vaginal wall in excision group (P 0.05). The length of anal exhaust, the time of hospitalization and the cost of hospitalization in the group without pneumoperitoneum were significantly lower than those in the group of pneumoperitoneum [2. 0 卤0. 6 days vs.(2.5 卤0. 5 vs.(2.5 卤2. 88 6 vs.(2.5 卤0. 006 卤1. 4 卤1. 4 vs.(8.2 卤1. 4 d vs.(8.2 卤1. 7 2 卤0. 07 2 卤0. 04 卤0. 04 卤0. 60 000 vs.(2.5 卤0. 5 000 vs.(2.5 卤0. 5 000]. No intraoperative complications occurred in all the groups. There was no significant difference in postoperative lymphatic retention cysts (17 / 4 / 24 / 19 / 5 / 26). Conclusion Laparoscopic radical pneumoperitoneum can avoid the effect of pneumoperitoneum on hemodynamics of human body, the respiratory and circulatory system is stable during operation, the intestinal function recovers quickly after operation, and the hospitalization time is short. Laparoscopic cervical cancer surgery can achieve the same radical effect, the elderly patients undergoing pneumoperitoneum laparoscopic radical cervical cancer surgery is safe and feasible.
【作者单位】：郑州大学第一附属医院妇科;
【分类号】：R737.33

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