【摘要】 目的:探讨早期输卵管癌腹腔镜全面分期手术的安全性及可行性。方法:回顾分析2011年1月至2013年12月腹腔镜探查术中冰冻病理报告为输卵管癌立即施行腹腔镜全面分期手术的4例患者。均行盆腔淋巴清扫,腹主动脉旁淋巴切除,漏斗韧带高位切断、双附件切除、子宫切除、大网膜切除、阑尾切除术,从阴道取出子宫、一侧附件、盆腔淋巴结、大网膜及阑尾。结果:4例手术均顺利完成,无中转开腹及术中、术后并发症发生,手术时间160~200 min,平均(180.5±30.1)min;术中出血量50~100 ml,平均(80.2±11.5)ml;清扫淋巴结17~28枚,平均(22.0±5.8)枚;术后肛门排气时间22~30 h,平均(26.1±5.8)h,术后48 h拔除尿管,无尿潴留、术后感染征象,术后住院8~13 d,平均(10.4±3.0)d。4例随访4~33个月,未发现复发,无腹壁穿刺孔转移。结论:早期输卵管癌腹腔镜全面分期手术安全可行,术后康复快,近期效果良好,在严格遵循手术适应证的前提下,可由有经验的妇科肿瘤医生施行腹腔镜早期输卵管癌分期手术。但其长期疗效尚需进一步大样本及前瞻性的研究观察。更多还原

【Abstract】 Objective: To investigate the safety and feasibility of comprehensive laparoscopic staging on early-stage fallopian carcinoma. Methods: From Jan. 2011 to Dec. 2013,4 patients with early stage fallopian carcinoma underwent comprehensive laparoscopic staging in our hospital. The clinical pathology and follow-up data of the patients were analyzed retrospectively. The key surgical steps included a comprehensive exploration of the pelvic abdominal cavity,frozen section,and then comprehensive staging surgery of the fallopian cancer( pelvic and para-aortic lymph node dissection,and then cutting off the funnel ligament,double attachments,uterus,omentum majus and appendix). The operators finally removed the uterus,unilateral attachment,pelvic lymph nodes,omentum majus and appendix from the vagina. Results: All the procedures were completed successfully without conversion to laparotomy,no major intraoperative or postoperative complications occurred. The operation time was 160-200 min( 180. 5 ± 30. 1) min,and intraoperative blood loss was 50-100 ml( 80. 2 ± 11. 5) ml. A mean of( 22. 0 ± 5. 8)( range,17-28) pelvic lymph nodes were removed during the procedure.The patients’ gastrointestinal function recovered in( 26. 1 ± 5. 8) h( range,22-30 h) after the surgery,and the urine catheter was removed in 48 h without uroschesis or infection. The mean postoperative hospital stay of the patients was( 10. 4 ± 3. 0) d( range,8-13 d). The patients were followed up for 4-33 months,during which no recurrence or metastasis to the puncture site was observed. Conclusions: Comprehensive laparoscopic staging is safe and feasible for early-stage fallopian carcinoma with good short-term outcomes and quick postoperative recovery. On the premise of strict indication,experienced gynecologic oncology surgeon can perform the laparoscopic procedure,but the long-term therapeutic effect still needs large-sample and prospective study.更多还原