外阴鳞癌腹股沟淋巴结清扫术腹腔镜与开放性手术的对比研究

发布时间：2018-02-17 06:56

本文关键词： 外阴鳞癌腹股沟淋巴结清扫术腹腔镜开放性　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:将外阴鳞癌手术治疗中腹股沟淋巴结清扫术腹腔镜与开放性手术进行对比研究,分析外阴鳞癌腹腔镜下腹股沟淋巴结清扫术(Video Endoscopic Inguinal Lymphadenectomy,VEIL)的临床疗效及经济学指标,评价VEIL的临床应用价值及可推广性。方法:通过病案管理系统,回顾性分析2011年10月至2016年10月在运城市中心医院、长治医学院附属和平医院、山西省肿瘤医院三家医院39例外阴鳞癌患者,其中15例患者(ⅠA期5例,ⅠB期5例,Ⅱ期1例,Ⅲ期4例)行VEIL+外阴广泛切除术(Radical Vulvectomy,RV),列为腹腔镜组;24例患者(ⅠA期5例,ⅠB期7例,Ⅱ期7例,Ⅲ期4例,外阴肿物切除术后复发1例)行开放式腹股沟淋巴结清扫术(Open Lymphadenectomy,OPL)+RV,列为开放式组。所有纳入患者术前外阴活组织检查或肿物切除后均经病检确诊为外阴鳞癌。腹腔镜组和开放式组患者的年龄(岁)为(58.20±7.18)vs.(55.83±7.12);身高(cm)为(158.47±5.78)vs.(159.46±4.44);体重(kg)为(61.60±10.68)vs.(60.04±5.87)。回顾性分析两组患者总住院天数、术后住院天数、手术时间、术中出血量、分别清扫左右侧淋巴结数目、术后引流管放置天数、总住院费用、手术费、麻醉费、术后相关费用、术后并发症发生率、复发转移情况、随访情况。采用SPSS19.0中χ2检验和独立样本t检验对所获得的数据进行统计分析。结果:两组患者均成功实施了腹股沟淋巴结清扫术+外阴广泛切除术;两组患者术前临床FIGO分期和年龄、身高、体重差异均无统计学意义。腹腔镜组与开放式组相比,结果如下:1.住院相关指标:腹腔镜组住院总天数(d)(19.07±5.19 vs.23.58±6.83,P=0.035)、术后住院天数(d)(13.13±2.80 vs.16.29±4.53,P=0.021)短于开放式组,差异均有统计学意义。2.手术相关指标:腹腔镜组与开放式组手术时间(min)(159.38±48.39 vs.153.13±28.26,P=0.654)、左侧(7.13±3.72 vs.8.50±4.04,P=0.297)或右侧(8.20±4.25 vs.7.67±3.53,P=0.674)切除淋巴结的数目等差异均无统计学意义;而术中出血量(ml)(57.33±37.31 vs.95.42±54.37,P=0.023)、术后引流管放置时间(d)(27±2.09 vs.11.88±3.84,P=0.009)差异有统计学意义。3.术后并发症情况:术后总并发症(近期并发症:腹股沟区皮瓣坏死、伤口感染、伤口裂开、淋巴囊肿和远期并发症:下肢淋巴水肿、淋巴漏)发生率(20.0%vs.29.2%,P=0.026)差异有统计学意义。4.术后病理资料及复发情况:术后阳性淋巴结例数(3例vs.5例,P=0.950)无统计学意义;腹腔镜组有1例经下肢通路置镜孔处复发转移(1/15,6.67%);开放式组有3例复发,其中2例为外阴局部复发,1例为右侧腹股沟区复发(3/24,12.5%)。5.经济学指标:腹腔镜组住院总费用(元)(20589.02±3874.83 vs.25141.19±5104.93,P=0.005)、手术费用(元)(4443.33±254.32 vs.3406.67±214.73,P0.001)、术后相关费用(元)(5094.42±1391.87 vs.9495.14±3074.21,P0.001)均少于开放式组,具有统计学意义;麻醉费用(元)(1292.00±352.28 vs.1212.63±134.42,P=0.324)无明显差别。对所有患者进行2个月的随访,期间两组患者术后均未出现因外阴鳞癌复发死亡情况。结论:1.腹腔镜手术可以达到跟开放性手术一样控瘤效果,在手术时间、清扫淋巴结数目方面与开放式手术相当,在术中出血量、术后引流管放置时间、术后住院天数及术后并发症的发生率等均优于开放性手术;2.VEIL对外阴鳞癌患者有更好的经济学效益;3.对于外阴鳞癌的手术治疗,VEIL是一种可行的手术方式,值得推广;4.对于术后远期复发情况,仍需要长期的随访进行大数据的对比研究。
[Abstract]:Objective: surgical treatment of vulvar squamous cell carcinoma of abdominal inguinal lymph node dissection in laparoscopic and open surgery for comparative study, analysis of squamous cell carcinoma of vulva of laparoscopic inguinal lymph node dissection (Video Endoscopic Inguinal Lymphadenectomy, VEIL) the clinical efficacy and economic indicators, to evaluate the clinical value of VEIL and replicability. Methods: the medical records management system, a retrospective analysis from October 2011 to October 2016 in Yuncheng Central Hospital, the affiliated Heping Hospital of Changzhi Medical College, Shanxi Provincial Tumor Hospital, three hospitals in 39 cases of vulvar squamous cell carcinoma patients, including 15 patients (5 cases, 5 cases of type A, type B 1 cases, stage II III in 4 cases) underwent VEIL+ resection of vulva (Radical Vulvectomy, RV), as the laparoscopic group; 24 patients (1 cases recurred in 5 cases, type A type B in 7 cases, 7 cases of stage II, 4 cases of stage III vulvar tumor resection) underwent open inguinal lymph node Sweep operation (Open Lymphadenectomy, OPL +RV), as the open group. All patients in preoperative vulvar biopsy or tumor resection were confirmed by pathological examination confirmed the diagnosis of vulvar squamous cell carcinoma. The laparoscopic group and open group of patients age (years) for (58.20 + 7.18) vs. (55.83 + 7.12) height; (CM) for (158.47 + 5.78) vs. (159.46 + 4.44); weight (kg) for (61.60 + 10.68) vs. (60.04 + 5.87). A retrospective analysis of two patients total hospitalization, postoperative hospitalization time, operation time, intraoperative blood loss, number of lymph nodes dissection of left and right sides respectively. Days after drainage tube placement, the total cost of hospitalization, operation fee, anesthetic fee, postoperative related costs, the incidence of postoperative complications, recurrence and metastasis, followed by SPSS19.0 in the 2. Chi square test and independent sample t test to obtain the data for statistical analysis. Results: two patients were successfully implemented. Inguinal lymph node dissection + vulva Wide excision; two groups of patients with clinical FIGO stage and age, height, weight. There were no significant differences in the laparoscopic group and open group, the results are as follows: 1. hospital related indicators: total length of hospital stay in laparoscopic group (d) (19.07 + 5.19 vs.23.58 + 6.83, P=0.035), postoperative hospital stay (d (vs.16.29) 13.13 + 2.80 + 4.53, P=0.021) shorter than the open group, the relevant indicators showed significant differences in.2. surgery: laparoscopic group and open surgery group (min) time (159.38 + 48.39 vs.153.13 + 28.26, P=0.654), left (7.13 + 3.72 vs.8.50 + 4.04, P=0.297 (8.20) or right + 4.25 vs.7.67 + 3.53 P=0.674), the number of lymph nodes removed, there were no significant differences; and the amount of bleeding (ML) (57.33 + 37.31 vs.95.42 + 54.37, P=0.023), postoperative drainage tube placement time (d) (27 + 2.09 vs.11.88 + 3.84, P=0.009) with statistically significant difference.3. after the operation In case of total postoperative complications (complications: groin flap necrosis, wound infection, wound dehiscence, lymphatic cyst and long-term complications: lower extremity lymphedema, lymph leakage) incidence rate (20.0%vs.29.2%, P=0.026) there was a significant difference between the.4. postoperative pathological data and recurrence of postoperative lymph node positive cases (3 cases of vs.5 patients, P=0.950) had no statistical significance; 1 cases in laparoscopic group by lower extremity pathway of a mirror hole recurrence (1/15,6.67%); the open group there were 3 cases of recurrence, including 2 cases of local recurrence of vulva, 1 cases of right inguinal region recurrence (3/24,12.5%).5. economic indicators: total laparoscopic group the cost (yuan) (20589.02 + 3874.83 vs.25141.19 + 5104.93, P=0.005), operation cost (yuan) (4443.33 + 254.32 vs.3406.67 + 214.73, P0.001), postoperative related costs (yuan) (5094.42 + 1391.87 + 3074.21 vs.9495.14, P0.001) were less than the open group, with the Statistical significance; the cost of anesthesia (yuan) (1292 + 352.28 vs.1212.63 + 134.42, P=0.324). There was no significant difference between the 2 months of follow-up for all patients during the two groups of patients were not due to recurrence of vulvar squamous cell carcinoma death. Conclusion: laparoscopic surgery can reach 1. with open surgery as tumor control effect and in the time of operation, the number of lymph nodes with open surgery, the intraoperative bleeding volume, postoperative drainage tube time, postoperative hospital stay and postoperative complications were superior to open surgery; 2.VEIL external vulvar squamous cancer patients have better economic benefits; 3. for the surgical treatment of vulva squamous cell carcinoma, VEIL is a feasible operation, worthy of promotion; 4. for the recurrence after operation, still need long-term follow-up study of big data.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.35

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