腹腔镜手术与开腹手术治疗早期子宫内膜癌的临床比较

发布时间：2018-04-13 02:08

  本文选题：子宫内膜癌 + 腹腔镜手术　； 参考：《浙江大学》2016年硕士论文

【摘要】：研究背景和目的子宫内膜癌是常见的妇科肿瘤之一,且发病率逐年上升。子宫内膜癌早期即可有不规则阴道流血流液等症状,大部分子宫内膜癌能够在早期被发现,且大多数都能靠手术达到治愈的目的,死亡率较低。目前对于子宫内膜癌的手术方式主要有机器人辅助下腹腔镜下手术、腹腔镜下手术及常规剖腹手术三种,文献研究显示微创手术已在子宫内膜癌的治疗方面显示出较大优势,但由于不同的医疗中心存在设备和技术的差异,在腹腔镜手术和开腹手术的比较结果方面尚存在差异,本研究通过回顾性分析2006年2月至2016年2月在本院行腹腔镜和开腹手术治疗的早期子宫内膜癌患者,对比腹腔镜手术与开腹手术治疗在各方面的差异和效果。研究方法回顾性分析2006年2月至2016年2月本院302例手术治疗的子宫内膜癌患者,选取其中行筋膜外子宫全切加双侧附件切除加盆腔及腹主动脉旁淋巴结清扫术的86例Ⅰ-Ⅱ期早期子宫内膜癌,其中腹腔镜组52例,开腹组34例,比较两组的手术时间、术中出血量、术中并发症、病理类型、淋巴结切除数量、术后住院时间、肛门排气恢复时间、留置导尿时间及术后生存率等指标。研究结果两组患者术前的基本特征包括年龄、BMI、合并症(高血压、糖尿病)、FIGO分期之间无统计学差异(p0.05)。腹腔镜组平均手术时间为(184.33±38.68)min,开腹组平均手术时间为(187.56±58.70)min,两组手术时间无显著性差异(P0.05),腹腔镜组的术中出血量为40(20-50)ml,开腹组的术中出血量为200(100-262.5)ml,腹腔镜组的术中出血量显著少于开腹组,差异有显著性(P0.01)。腹腔镜组术中有1例发生术中输尿管损伤(1.92%),无术中输血,开腹组患者无术中输尿管损伤,有2例术中输血(5.88%)。腹腔镜组的术后住院时间为(5.71±1.91)天,开腹组的术后住院时间为(8.88±2.79)天,腹腔镜组术后住院时间较短,差异有显著性(P0.01)；腹腔镜组的住院费用为(25174.99±4242.66)元,开腹组的住院费用为(20351.73±3916.16)元,开腹组的住院费用较少,差异有显著性(P0.01)。腹腔镜组切除淋巴结数量为(20.25±9.02)个,开腹组切除淋巴结数量为(17.97±8.34),两组相比无显著性差异(P0.05)。腹腔镜组术后肛门排气时间为(2.25±0.56)天,开腹组术后肛门排气时间为(3.41±0.86)天,腹腔镜组术后肛门恢复排气时间较短,差异有显著性(P0.01)。腹腔镜组术后留置导尿时间为(2.38±0.75)天,开腹组术后留置导尿时间为(3.76±1.13)天,腹腔镜组术后留置导尿时间较短,差异有显著性(P0.01)。腹腔镜组的5年生存率分别为95.5%,开腹组的5年生存率分别为92.9%,两组相比无显著性差异(P0.05)。腹腔镜组5年无瘤生存率为93.2%,开腹组5年无瘤生存率为89.3%,两组相比无显著性差异(P0.05)。研究结论本研究表明,腹腔镜与开腹手术在早期子宫内膜癌内膜癌治疗上疗效相当,但腹腔镜手术具有创伤小、术中出血少、术后患者恢复快及绝对生存率高等优势,其可作为子宫内膜癌优先的治疗方法之一。
[Abstract]:Background and objective endometrial carcinoma is one of the most common gynecologic tumors, and the incidence rate is rising year by year. The early stage of endometrial carcinoma with irregular vaginal bleeding sap and other symptoms, most of endometrial cancer can be found in the early stage, and most of them can achieve the purpose of cure by surgery, mortality rate is low. The operation mode endometrial cancer mainly in robot assisted laparoscopic surgery, surgery and conventional laparotomy three laparoscopic, minimally invasive surgery has literature research shows that in the treatment of endometrial cancer has shown great advantages, but due to the differences in equipment and technology in different medical center, the results of the comparison of laparoscopic and open surgery of the hand there are still differences, this study through a retrospective analysis from February 2006 to February 2016 in the early stage of our hospital laparoscopic and open surgery in the treatment of endometrial cancer In contrast, laparoscopic surgery and open surgery for differences in various aspects and effects. Methods Retrospective analysis of treatment from February 2006 to February 2016 in our hospital 302 cases of patients with endometrial cancer, 86 cases of them underwent selected extrafascial total hysterectomy with bilateral oophorectomy and pelvic and paraaortic lymph node dissection II the early stage of endometrial carcinoma, 52 cases were treated with laparoscopic and laparotomy group 34 cases, compared two groups of operation time, intraoperative blood loss, intraoperative complications, pathological type, lymph node resection, postoperative hospitalization time, anal exhaust recovery time, rate of survival time and postoperative indwelling catheterization. The basic characteristics of the two groups of patients before surgery include age, BMI, comorbidities (hypertension, diabetes), no significant difference between FIGO staging (P0.05). The average operative time of laparoscopic group (184.33 + 38.68) min, the open group average 鎵嬫湳鏃堕棿涓，

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