【摘要】 目的探讨腹腔镜广泛子宫切除联合盆腔淋巴结清扫术治疗子宫恶性肿瘤的临床价值。方法气管插管静脉复合麻醉,膀胱截石位。放置举宫器,建立气腹,脐孔及左右两侧腹壁穿刺置入trocar。先行双侧盆腔淋巴结清扫,自上而下清扫髂总、髂外、腹股沟深3组淋巴结,进而清扫闭孔及髂内2组淋巴结。子宫动脉自髂内动脉起始处游离凝断,游离输尿管,分离双侧膀胱侧窝、直肠侧窝,游离主韧带、骶韧带3.0 cm以上切除,下推膀胱、直肠,游离阴道壁3.0 cm以上,并于3.0 cm处切除子宫标本,标本经阴道取出。结果 28例全部手术成功,无中转开腹。18例宫颈癌手术时间(213.3±38.6)min,术中出血量(223.3±89.6)ml,膀胱功能恢复时间(16.5±4.3)d,切除淋巴结(14.3±6.8)枚,术后并发症发生率16.7%(3/18),术后发热时间(4.3±2.6)d,术后肛门排气时间(20.4±3.8)h;术后3例(16.7%,3/18)补充放疗、化疗。10例子宫内膜癌手术时间(221.3±37.7)min,术中出血量(231.9±71.4)ml,膀胱功能恢复时间(14.2±9.1)d,切除淋巴结(15.9±7.3)枚,术后1例发生并发症,术后发热时间(4.6±3.4)d,术后肛门排气时间(19.2±8.9)h;术后2例补充放疗、化疗。所有病例断端及阴道切缘均阴性。28例术后随访3~23个月,平均20个月,无复发,无一例发生穿刺部位肿瘤种植。结论腹腔镜广泛子宫切除联合盆腔淋巴结清扫术治疗子宫颈癌和子宫内膜癌,手术视野清晰,手术安全,效果理想。更多还原

【Abstract】 Objective To explore the clinical value of laparoscopic radical hysterectomy and pelvic lymphadenectomy for the treatment of uterine carcinomas. Methods Under endotracheal intubation and intravenous anesthesia,with the patients being placed in lithotomy position,uterus lifting apparatus was employed,then pneumoperitoneum was established. Trocars were placed in the umbilicus,left and right sides of the abdominal wall. We performed lymph node dissection of 3 groups which were from common iliac,external iliac and groin,then the two groups of lymph nodes of obturator and internal iliac. After separating and cutting off the uterine artery by electrocoagulation at the beginning of internal iliac artery,we separated the ureter and isolated perirectal and perivesical fossae of bilateral sides. Afterwards,we resected cardinal ligament and sacral ligament following separating them for more than 3. 0 cm. After pushing down bladder and rectum,we resected the uterine at vaginal wall where it had been freed for more than 3 cm. The uterus were taken out through the vagina. Results All the laparoscopic operations were successfully performed without convertion to open surgery. In 18 cases of cervical cancer,the mean operation time was( 213. 3 ± 38. 6) min,intraoperative blood loss was( 223. 3 ± 89. 6) ml,bladder function recovery time was( 16. 5 ± 4. 3) d,the number of the excised lymph node was 14. 3 ± 6. 8, and the incidence of postoperative complication was 16. 7%( 3 /18). Postoperative fever lasted for( 4. 3 ± 2. 6) d,and postoperative anal exhaust time was( 20. 4 ± 3. 8) h. Three cases( 16. 7%) received supplementary postoperative radiotherapy and chemotherapy. In 10 cases of endometrial carcinoma,the mean operation time was( 221. 3 ± 37. 7) min,intraoperative blood loss was( 231. 9 ± 71. 4) ml, bladder function recovery time was( 14. 2 ± 9. 1) d,and the number of the excised lymph node was 15. 9 ± 7. 3. Postoperative complication occurred in 1 case. Postoperative fever lasted for( 4. 6 ± 3. 4) d,and postoperative anal exhaust time was( 19. 2 ± 8. 9) h. Two cases received supplementary postoperative radiotherapy and chemotherapy. All cases of vaginal stump and cutting edge were negative. A mean follow-up of 20 months( range,3- 23 months) showed no recurrence or implantation metastasis at the site of puncture. Conclusion Laparoscopic radical hysterectomy and pelvic lymphadenectomy for the treatment of cervical and endometrial cancer is safe and feasible,with clear surgical field and satisfactory efficacy.更多还原