腹腔镜下和经腹广泛子宫切除及盆腔淋巴结清扫术治疗早期子宫恶性肿瘤的近期疗效分析

目的:探讨腹腔镜下广泛子宫切除加盆腔淋巴结清扫术治疗子宫恶性肿瘤的近期疗效及应用价值.方法:对协和医院妇产科2008年3月至2009年4月间的70例早期子宫恶性肿瘤患者行腹腔镜下广泛子宫切除加盆腔淋巴结清扫术(TLRH+LPL组),并与同期48例经腹广泛子宫切除术和淋巴结清扫术(ARH+APL组)的病例作为对照,比较两种术式的术中、术后情况及并发症等.结果:行腹腔镜手术的70例患者,有2例中转开腹,中转率为2.9%.TLRH+LPL组在手术时间、术中出血量、淋巴结切除数目和术后体温恢复正常平均时间上与ARH+APL组相比,具有明显优势,差异均有高度统计学意义(P<0.01);但膀胱功能恢复时间及术后并发症的发生率,两组比较差异无统计学意义(P>0.05).结论:腹腔镜下广泛子宫切除加盆腔淋巴结清扫术具有同常规的经腹手术同样的安全性和有效性,同时缩短了手术时间,减少了手术创伤,为微创手术治疗妇科恶性肿瘤提供了良好的应用前景.     

腹腔镜广泛全子宫切除加盆腔淋巴结清扫术治疗子宫恶性肿瘤安全性分析

目的探讨子宫恶性肿瘤腹腔镜广泛全子宫切除加盆腔淋巴结清扫术的安全性及并发症的防治。方法对中山大学附属佛山医院1998年8月至2006年1月行腹腔镜广泛全子宫切除加盆腔淋巴结切除术治疗95例子宫颈癌和85例子宫内膜癌的手术时间、术中出血量、淋巴结切除数目、术中及术后并发症临床资料进行回顾性分析。结果中转开腹率1.67%(3/180),手术时间(255±69)min,术中出血量(347±247)mL,淋巴结切除(20±8)个。术中膀胱损伤7例(3.89%),大血管损伤6例(3.33%)。术后并发尿潴留41例(22.78%),淋巴囊肿7例,输尿管瘘2例,膀胱阴道瘘、尿失禁、肠梗阻各1例。结论随着腹腔镜技术的不断熟练和并发症防治技巧的掌握,子宫恶性肿瘤腹腔镜下广泛全子宫切除加盆腔淋巴结切除有望成为一种极具潜力的手术方式。     

腹腔镜与开腹手术行广泛子宫切除加盆腔淋巴结清除术的临床效果比较

目的 比较腹腔镜与开腹手术行广泛子宫切除加盆腔淋巴结清除术的临床效果。方法 回顾性分析近2年我院经腹腔镜行广泛子宫切除加盆腔淋巴结清除术的26例子宫恶性肿瘤患者(腹腔镜组)的临床资料,随机抽取近4年行开腹同类手术的27例(开腹组)作为对照。结果腹腔镜组平均手术时间为310 min,开腹组为238 min;腹腔镜组平均切除的淋巴结22个,开腹组为16个;腹腔镜组术中平均出血量为756 ml,开腹组为1129 ml,腹腔镜组平均输血量为321 m1,开腹组为746 ml,腹腔镜组平均术后排气时间为37 h,开腹组为62 h;腹腔镜组术后体温恢复正常时间平均为5 d,开腹组为8 d;腹腔镜组平均应用抗生素时间为6 d,开腹组为8 d;以上各项数据两组间比较,差异均有极显著性(P<0.01)。两组在盆腔引流液(分别为321、216 ml)、尿管拔除时间(分别为13、10d)、术后第3天的白细胞计数(分别为11 × 109/L、10 × 109/L)、术后住院日(分别为26、26 d)及住院费用(分别为25 986、22 672元)等方面比较,差异均无显著性(P>0.05)。结论 腹腔镜下广泛子宫切除及盆腔淋巴结清除术可达到开腹手术的彻底性,并具有创伤小、恢复快等优点。     

腹腔镜联合阴式手术治疗早期子宫恶性肿瘤的临床价值

目的探讨腹腔镜盆腔淋巴切除 阴式广泛全子宫切除术(LPL VRH)治疗早期子宫恶性肿瘤的临床价值。方法2003年8月至2007年12月,选择11例早期子宫颈癌和8例子宫内膜癌的患者行LPL VRH治疗(研究组),选取同时入院接受开腹子宫广泛切除 淋巴切除术治疗早期子宫颈癌11例、子宫内膜癌8例为对照组,对其手术情况、手术时间、术后并发症、术中出血量、淋巴结切除数目、术后病率进行比较。结果研究组19例中18例成功手术,1例因淋巴结切除困难中转开腹。研究组与对照组在术中出血[(321.08±284.36)mL,(513.62±237.23)mL]、术后胃肠恢复时间(1.5d,4.5d)、术后下床活动时间(2d,7d),两组间比较差异有统计学意义(P<0.05)。而两组在手术时间、术中清除淋巴结数、术后尿潴留、尿失禁、淋巴囊肿及术后复发等指标上差异无统计学意义(P>0.05)。结论LPL VRH可作为早期子宫恶性肿瘤手术治疗方法之一,近期效果良好,远期疗效有待进一步观察。     

腹腔镜手术治疗子宫恶性肿瘤72例临床分析

目的探讨子宫恶性肿瘤腹腔镜手术治疗的可行性与实用价值.方法对2000年8月至2005年1月间沈阳市妇婴医院26例子宫颈癌和6例子宫内膜癌行腹腔镜下广泛或次广泛子宫切除及盆腔淋巴结清扫术,对33例子宫内膜癌行筋膜外子宫全切、双附件切除及盆腔淋巴结清扫术,对7例Ⅰb1期前子宫颈癌患者行腹腔镜下盆腔淋巴结清扫术及宫颈根治术.分析其手术时间、术中出血量、淋巴结清除数目、术后恢复情况.结果腹腔镜下广泛(或)次广泛子宫切除术及盆腔淋巴结清扫术的平均手术时间(261±62)min,平均出血量(357±46)mL,平均清除淋巴结(21.7±4.5)个.术后尿潴留9例.结论子宫恶性肿瘤的腹腔镜手术因其独具优势而有发展前景,手术成功的关键在于适应证的正确选择及操作技术的熟练.     

腹腔镜手术治疗子宫恶性肿瘤52例分析

目的　总结腹腔镜手术治疗子宫恶性肿瘤的临床资料。方法　 1999年 8月至 2 0 0 2年 7月对 37例子宫内膜癌 ,15例子宫颈癌行腹腔镜手术 ,其中广泛全子宫切除加双附件切除术 30例 ,广泛全子宫切除加双附件切除加盆腔淋巴结清扫术 2 2例 ;对子宫内膜癌Ⅰb期G2 、G3 的 14例患者同时行腹主动脉旁淋巴结活检术。结果　 37例子宫内膜癌全部手术成功 ,无一例出现术中并发症 ,平均手术时间 (2 2 0 4 0± 4 7 89)min ,出血量 (96 6 7±33 39)mL ,术前、后诊断符合率 :Ⅰa期 2 0 0 0 % ,Ⅰb期 6 1 90 % ,术后 3年阴道残端复发 1例 ;15例子宫颈癌患者中 ,中转开腹 1例 ,髂外静脉损伤 2例 ,平均手术时间 (316 11± 6 3 2 4 )min ,出血量 (381 6 7± 74 0 9)mL ,平均切除淋巴结 (18 4 3± 1 6 3)粒 ,术后 1年盆腔侧壁复发 1例。腹腔镜手术治疗子宫恶性肿瘤成功率 98 0 8%。结论　腹腔镜手术治疗子宫恶性肿瘤近期效果良好 ,远期效果有待随访。     

腹腔镜手术治疗早期子宫恶性肿瘤23例

目的探讨腹腔镜手术治疗早期子宫恶性肿瘤的可能性和安全性.方法采用电视腹腔镜技术对23例早期子宫恶性肿瘤患者进行手术治疗,其中16例子宫内膜癌施行腹腔镜下广泛子宫切除加双附件切除术,5例子宫颈癌及另2例子宫体癌行腹腔镜下盆腔淋巴结清扫加广泛子宫切除术.结果腹腔镜广泛子宫切除术平均手术时间215.44min,术中失血量278.38 ml,腹腔镜盆腔淋巴结清扫加广泛子宫切除术平均手术时间300.86 min,术中失血量550 ml.术中无一例脏器损伤.平均住院时间8天.结论开展腹腔镜手术治疗早期子宫恶性肿瘤是可行的,安全的,值得研究与运用.     

腹腔镜手术治疗子宫恶性肿瘤8例分析

目的 探讨腹腔镜手术治疗子宫恶性肿瘤的临床效果。方法 对6例子宫内膜癌患者行腹腔镜下广泛全子宫切除＋双侧附件切除术;对2例子宫颈癌患者行腹腔镜下广泛全子宫切除＋双侧附件切除＋盆腔淋巴结切除术。观察手术时间、平均出血量及术后恢复情况。结果 广泛全子宫切除＋双侧附件切除术6例,平均手术时间220min,平均出血量200ml;腹腔镜下广泛全子宫切除＋双侧附件切除＋盆腔淋巴结切除术2例,平均手术时间240min。术中无一例脏器损伤、术后平均住院8d。结论 腹腔镜手术创伤小、恢复快、对早期子宫恶性肿瘤具有较好治疗效果。     

腹腔镜下广泛全子宫切除加盆腔淋巴结切除术治疗子宫恶性肿瘤85例临床分析

目的　分析腹腔镜下广泛全子宫切除术加盆腔淋巴结切除术治疗子宫恶性肿瘤的实用价值。方法　回顾分析 1999年 8月至 2 0 0 3年 12月 5 1例子宫颈癌和 34例子宫内膜癌的手术情况 ,总结其手术时间、术中出血量、淋巴结切除数目及预后情况。结果　盆腔淋巴结切除术成功率 10 0 % ,广泛全子宫切除术成功率 98 82 % ,手术时间 (2 86 4 3± 75 6 7)min ,术中出血量 (331 0 8± 2 94 32 )mL ,淋巴结切除 (2 2 73± 5 79)个 ,术中重要脏器损伤发生率 8 2 4 % ,术后并发症发生率 30 5 9% ,子宫颈癌术后复发率 7 80 % ,子宫内膜癌术后复发率 2 94 %。结论　腹腔镜下广泛全子宫切除加盆腔淋巴结切除术可以作为早期子宫恶性肿瘤手术治疗的方法之一 ,短期效果良好 ,远期疗效有待观察     

腹腔镜下腹主动脉旁淋巴结切除在子宫内膜癌诊治中的临床研究

目的:探讨腹腔镜下腹主动脉旁淋巴结切除在子宫内膜癌诊治中的应用价值及安全性、可行性。方法:选择2010年3月至2014年3月子宫内膜癌患者89例,其中,行腹腔镜下腹主动脉旁淋巴结切除手术50例(腹腔镜组),传统开腹腹主动脉旁淋巴结切除手术39例(开腹组),比较两组围手术期情况、术中及术后并发症、预后,统计分析淋巴结转移患者临床病理特征。结果:腹腔镜组和开腹组患者在切除的淋巴结数目上差异无统计学意义(P0.05),腹腔镜组较开腹组腹主动脉旁淋巴结切除出血量少、术后病率低、术后肛门排气时间早、术后住院时间短,但切除腹主动脉旁淋巴结时间长于开腹组,两组比较差异均有统计学意义(P0.01,P0.05)。腹腔镜组与开腹组在术中腔静脉损伤、术后尿潴留、淋巴囊肿、深静脉血栓、肺动脉栓塞发生率比较,差异无统计学意义(P0.05),而开腹组切口裂开4例,腹腔镜组无切口裂开,两组比较差异有统计学意义(P0.05)。术后发现盆腔和(或)腹主动脉旁淋巴结转移共8例,除术前1例患者发现脐部癌转移诊断为ⅣB期和1例患者磁共振成像提示盆腔淋巴结肿大癌转移诊断ⅢC1期与术后病理诊断相同外,其余6例分期均较术前升高。两组术后随访:开腹组复发2例,其中1例死亡;腹腔镜组复发1例后死亡,均为晚期子宫内膜癌患者。结论:腹主动脉旁淋巴结切除是子宫内膜癌规范化诊治的重要组成部分,在对子宫内膜癌患者准确分期、制定精确术后诊治方案,改善预后方面作用是肯定的,腹腔镜下腹主动脉旁淋巴结切除手术安全可行,优于传统开腹手术。     

Laparoscopic detection of sentinel lymph nodes followed by lymph node dissection in patients with early stage cervical cancer

OBJECTIVE: The purpose of this study was to investigate the feasibility of sentinel node detection through laparoscopy in patients with early cervical cancer. Furthermore, the results of laparoscopic pelvic lymph node dissection were studied, validated by subsequent laparotomy. METHODS: Twenty-five patients with early stage cervical cancer who planned to undergo a radical hysterectomy and pelvic lymph node dissection received an intracervical injection of technetium-99m colloidal albumin as well as blue dye. With a laparoscopic gamma probe and with visual detection of blue nodes, the sentinel nodes were identified and separately removed via laparoscopy. If frozen sections of the sentinel nodes were negative, a laparoscopic pelvic lymph node dissection, followed by radical hysterectomy via laparotomy, was performed. If the sentinel nodes showed malignant cells on frozen section, only a laparoscopic lymph node dissection was performed. RESULTS: One or more sentinel nodes could be detected via laparoscopy in 25/25 patients (100%). A sentinel node was found bilaterally in 22/25 patients (88%). Histological positive nodes were detected in 10/25 patients (40%). One patient (11%) had two false negative sentinel nodes in the obturator fossa, whereas a positive lymph node was found in the parametrium removed together with the primary tumor. In seven patients (28%), the planned laparotomy and radical hysterectomy were abandoned because of a positive sentinel node. Bulky lymph nodes were removed through laparotomy in one patient, and in six patients only laparoscopic lymph node dissection and transposition of the ovaries were performed. These patients were treated with chemoradiation. In two patients, a micrometastasis in the sentinel node was demonstrated after surgery. Ninety-two percent of all lymph nodes was retrieved via laparoscopy, confirmed by laparotomy. Detection and removal of the sentinel nodes took 55 +/- 17 min. Together with the complete pelvic lymph node dissection, the procedure lasted 200 +/- 53 min. CONCLUSION: Laparoscopic removal of sentinel nodes in cervical cancer is a feasible technique. If radical hysterectomy is aborted in the case of positive lymph nodes, sentinel node detection via laparoscopy, followed by laparoscopic lymph node dissection, prevents potentially harmful and unnecessary surgery.     

Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer--a prospective randomized trial

OBJECTIVE: We compared a laparoscopic-vaginal approach with the conventional abdominal approach for treatment of patients with endometrial cancer. METHOD: Between July 1995 and August 1999, 70 patients with endometrial cancer FIGO stage I-III were randomized to laparoscopic-assisted simple or radical vaginal hysterectomy or simple or radical abdominal hysterectomy with or without lymph node dissection. RESULTS: Thirty-seven patients were treated in the laparoscopic versus 33 patients in the laparotomy group. Lymph node dissection was performed in 25 patients by laparoscopy and in 24 patients by laparotomy. Blood loss and transfusion rates were significantly lower in the laparoscopic group. Yield of pelvic and para-aortic lymph nodes, duration of surgery, and incidence of postoperative complications were similar for both groups. Overall and recurrence-free survival did not differ significantly for both groups. CONCLUSION: The laparoscopic-vaginal approach for treatment of endometrial cancer is associated with lower perioperative morbidity compared with the conventional abdominal approach.     

Endometrium- und Zervixkarzinom

Laparoscopic management of gynaecologic cancer has been controversial for decades. Much technical progress has however been achieved, enabling experienced endoscopic surgeons to perform most gynaeco-oncologic procedures such as hysterectomy, omentectomy, and pelvic and para-aortic lymph node dissection. Although the oncologic value of laparoscopy with respect to safety and patient outcome has not yet been shown in prospective randomized clinical trials, many studies with thousands of patients have revealed similar oncologic results and its feasibility when compared to laparotomy. Especially the lymph node yield has been shown to be similar with both laparoscopic and open surgical methods. This approach has therefore become well accepted for cervical and endometrial carcinomas, especially in early stages. In addition, a staging laparoscopy including pelvic and paraaortic lymph node sampling and debulking contributes to accurately stage advanced cervical cancer cases in order to achieve the adequate treatment.     

Clinical outcome and complications of laparoscopic surgery compared with traditional surgery in women with endometrial cancer

Introduction The purpose of this study was to evaluate the feasibility, clinical outcome and complications of laparoscopic surgery in women with endometrial cancer and to compare surgical outcome and postoperative early and late complications with results of traditional laparotomy. Methods Forty women with endometrial cancer underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Each patient operated by laparoscopy was matched by age, preoperative clinical stage and histology of the endometrial cancer with a patient treated by the same operation but using traditional laparotomy. Half of these patients underwent total pelvic lymphadenectomy and half had pelvic lymph node sampling. The groups were compared in clinical characteristics, surgical outcomes, recoveries and early and late postoperative complications. Results The patients in the laparoscopy group had less blood loss, more lymph nodes removed, shorter hospital stay but longer operation time than those treated by laparotomy. Only one (2.5%) laparoscopy was converted to laparotomy due to pelvic adhesions. There were no intraoperative complications in either group. Postoperative complications were more common (55.0%) in the laparotomy than in the laparoscopy group (37.5%). Only one major complication (2.5%) occurred among patients undergoing laparoscopy as compared with three (7.5%) major complications in the laparotomy group. Superficial wound infection was the most common (20%) infection in laparotomy patients while vaginal cuff cellulitis occurred in 10% of laparoscopy patients. Late (>42 days) postoperative complications were almost equally frequent (20.0 and 22.5%) in both groups. Lower extremity lymph edema or pelvic lymph cyst was found in 12.5% of all cases. As a result of surgical staging the disease of 6 women (15%) in both groups was upgraded. Conclusions Laparoscopic surgery is a viable alternative to traditional surgery in the management of endometrial cancer. The surgical outcome is similar in both cases. In laparoscopic procedures the operation time is longer but the postoperative recovery time shorter than in laparotomy. Severe complications were limited in both groups, while wound infections can be avoided using laparoscopy.     

Laparoscopic port-site metastasis of an early stage adenocarcinoma of the cervix with negative lymph nodes.

BACKGROUND: Port-site metastasis (PSM) following laparoscopic surgery for cancer is being increasingly recognized as a potential problem; the majority of cases appear following laparoscopy for a pelvic mass that subsequently proved to be malignant or in the case of a disseminated intraperitoneal disease. The rare cases of PSM following laparoscopy for endometrial and cervical cancer have all been associated with the presence of regional lymph node metastasis or disseminated disease in the peritoneal cavity. We present here a case report of PSM in the absence of spread beyond the primary tumor. CASE: A 48-year-old woman with stage IA1 adenocarcinoma of the cervix was treated with laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic node dissection. The pathologic study revealed an endocervical adenocarcinoma confined to the cervix with negative lymph nodes. Nine months postoperatively, a cutaneous metastasis at the port-site was diagnosed. This was treated with wide local excision of the recurrence and the port-site track. Explorative laparotomy and para-aortic node sampling showed no evidence of recurrence elsewhere. CONCLUSION: This case emphasizes the risk for PSM in laparoscopic surgery performed for early stage disease.     

Treatment of pelvic lymph node involvement in early stage cervical cancer

OBJECTIVES: Results of a retrospective paired study comparing the outcome of patients irradiated for lymph node involvement according to the method of node assessment: laparotomy or laparoscopy. MATERIAL AND METHODS: Twenty-six patients with cervical cancer managed by postoperative radiation therapy for pelvic node involvement during the Wertheim-Meigs operation (historical group) were compared to 26 patients in whom lymph node involvement was discovered at the time of laparoscopy and managed by definitive radiation therapy without hysterectomy (laparoscopy group). The patients were matched according to age, stage, tumor histology and tumoral volume. RESULTS: No difference was observed in the five-year survivals. Although it was not significant there were more grade 3-4 radio-induced complications in the historical group. CONCLUSIONS: The introduction of laparoscopy and the absence of hysterectomy did not impair the outcome of our patients. Laparoscopic lymphadenectomy reduces the risk of radio-induced adverse effects.     

腹腔镜手术与开腹手术治疗早期子宫颈癌的对比分析

目的 :探讨腹腔镜手术治疗早期子宫颈癌的价值。方法 :回顾性分析接受腹腔镜手术 (15例 )和剖腹手术(17例 )治疗的临床Ⅰ期宫颈癌患者的临床资料 ,比较两组的手术时间、术中出血量、手术并发症、术后恢复情况及疾病复发等。结果 :腹腔镜组 1例因膀胱损伤而中转开腹。 2例腹腔镜下广泛性子宫切除手术时间分别为 2 0 5分钟和 115分钟 ,出血分别为 75 0ml和 2 0 0ml;12例腹腔镜下广泛性子宫切除及盆腔淋巴结清扫术手术时间平均 30 3 7分钟 ,术中出血平均 393 3ml,平均切除淋巴结 15 3个。剖腹手术组手术时间平均 2 18 0分钟 ,术中出血平均 384 1ml,平均切除淋巴结 16 2个。腹腔镜和剖腹手术组术后病率分别为 5 0 %和 47 1%。腹腔镜组髂外静脉损伤 2例 ,剖腹手术组髂总静脉损伤 1例。两组术后尿潴留分别为 3例和 4例 ,淋巴囊肿分别为 4例和 2例。腹腔镜组手术时间明显长于剖腹手术组 (P<0 .0 1) ,其余指标差异无统计学意义。术后随访 3月至 4年 ,两组各 1例复发。结论 :腹腔镜下广泛性子宫切除及盆腔淋巴结清扫术可作为早期子宫颈癌手术治疗的方法之一。