机器人辅助广泛性子宫切除术和盆腔淋巴结切除术的初步研究

目的 探讨将机器人手术系统应用于宫颈癌的广泛性子宫切除+盆腔淋巴结切除术的可行性.方法 2008年12月-2009年8月,采用da Vinci机器人手术系统,对5例Ⅰb1～Ⅱ a期宫颈癌患者行机器人辅助广泛性子宫切除+盆腔淋巴结切除术.记录手术时间、术中出血量、术中及术后并发症的发生情况、手术前后血红蛋白含量变化、术后体温及排气时间、术后恢复自主排尿时间、术后住院时间、病理检查结果、盆腔淋巴结切除数等.结果 5例患者全部顺利完成手术,无中转开腹,无术中或术后并发症出现.5例患者的手术时间分别为305、365、275、240和245 min,平均为286 min;术中出血量分别约为200、400、650、300和400 ml,平均为390 ml.5例患者术后最高体温均未超过37.5℃,术后36 h均排气.5例患者术后住院时间分别为11、13、9、12和12 d,平均为11.4 d.5例患者的病理检查结果均为鳞状细胞癌,阴道残端和宫旁切缘均无残留病灶.盆腔淋巴结切除数分别为14、22、16、21和18个,平均为18.2个,淋巴结无转移.结论 机器人手术系统可以应用于宫颈癌的广泛性子宫切除+盆腔淋巴结切除术,这一新方法为宫颈癌的手术治疗提供了一个新的选择.

Preliminary study on laparoscopically robotic assisted radical hysterectomy and pelvic lymphadenectomy on cervical cancer

Objective To evaluate the feasibility of laparoscopically robotic assisted radical hysterectomy and pelvic lymphadenectomy in treatment of cervical cancer.Methods From Dec.2008 to Aug.2009,5 cervical cancer patients at stage Ⅰ bl to Ⅱ a underwent laparoscopically robotic assisted radical hysterectomy and pelvic lymphadenectomy.The following clinical parameters were recorded and compared,including operative time,blood loss,intraoperative and postoperative complications,the changes of hemoglobin before and after surgery,postoperative temperature,the time of postoperative anus exhaust and urination,hospitalization,pathologic exam,and the number of lymph nodes.Results Laparoscopically robotic assisted radical hysterectomy and pelvic lymphadenectomy were performed successfully on those 5 patients without the conversion to laparotomy.No intraoperative and postoperative complications were observed.The operative time were 305,365,275,240 and 245 minutes,respectively,with a mean value of 286 minutes.Estimated blood loss was 200,400,650,300 and 400 ml,respectively.The mean blood loss was 390 ml.Temperatures of all patients were not higher than 37.5℃ and anus exhaust was recovered at 36 hours after surgery.Those five patients were hospitalized for 11,13,9,12 and 12 days respectively.Squamous carcinoma of cervix were diagnosed by the pathologic examination.The resected margin of vagina and parametrium was clear.The numbers of pelvic lymph nodes were 14,22,16,21 and 18,respectively.No evidence of lymph nodes metastasis was found.Conclusion Laparoscopically robotic assisted radical hysterectomy and pelvic lymphadenectomy is feasible as a novel approach in the treatment of cervical cancer.