CAJ | 학술논문

目的：分析腹腔镜下广泛性子宫切除术联合盆腔淋巴结清扫术不同阶段的手术效果,探讨腹腔镜下广泛性子宫切除术联合盆腔淋巴结清扫术的学习曲线。方法回顾性分析2007年7月~2009年11月由同一组妇科医师完成的60例腹腔镜下广泛性子宫切除术联合盆腔淋巴结清扫术的宫颈癌患者,按手术先后顺序分为两组(A、B),每组30例,比较两组手术时间、术中出血量、检出盆腔淋巴结数量、恢复排气时间、恢复正常排尿时间及并发症情况。结果①两组病例在年龄、体质量指数、组织病理学类型、临床分期方面比较,差异均无统计学意义(P>0.05)；②B组平均手术时间明显短于A组,术中平均出血量明显少于A组,差异有统计学意义(P<0.05)；两组病例在检出盆腔淋巴结数量、恢复排气时间、恢复正常排尿时间方面比较,差异无统计学意义(P>0.05)；③A组手术并发症的发生率明显高于B组(P<0.05)。④随访16~40个月,2例患者复发,1例患者死亡。结论开展腹腔镜下广泛性子宫切除术及盆腔淋巴结清扫术是安全可行的,妇科手术医师行腹腔镜下宫颈癌根治术的学习曲线大约为30例,经过30例的手术操作,外科学结局明显改善。
목적：분석복강경하엄범성자궁절제술연합분강림파결청소술불동계단적수술효과,탐토복강경하엄범성자궁절제술연합분강림파결청소술적학습곡선。방법회고성분석2007년7월~2009년11월유동일조부과의사완성적60례복강경하엄범성자궁절제술연합분강림파결청소술적궁경암환자,안수술선후순서분위량조(A、B),매조30례,비교량조수술시간、술중출혈량、검출분강림파결수량、회복배기시간、회복정상배뇨시간급병발증정황。결과①량조병례재년령、체질량지수、조직병이학류형、림상분기방면비교,차이균무통계학의의(P>0.05)；②B조평균수술시간명현단우A조,술중평균출혈량명현소우A조,차이유통계학의의(P<0.05)；량조병례재검출분강림파결수량、회복배기시간、회복정상배뇨시간방면비교,차이무통계학의의(P>0.05)；③A조수술병발증적발생솔명현고우B조(P<0.05)。④수방16~40개월,2례환자복발,1례환자사망。결론개전복강경하엄범성자궁절제술급분강림파결청소술시안전가행적,부과수술의사행복강경하궁경암근치술적학습곡선대약위30례,경과30례적수술조작,외과학결국명현개선。
Objective To evaluate the surgical outcomes of laparoscopic radical hysterectomy and pelvic lymphadenectomy for cervical cancer and investigate learning curve of laparoscopic radical hysterectomy and pelvic lymphadenectomy. Methods Clinical data of 60 cases of laparoscopic radical hysterectomy and pelvic lymphadenectomy for cervical cancer performed by a group of surgeons were reviewed. The cases were divided equally into two groups (groups A and group B) according to the sequence of the operations. The operating time, blood loss, numbers of pelvic lymph nodes resected, time to normal defecation and residual urine and intra-and postoperative complications were compared between the two groups. Results ①There were no significant differences between the two groups with respect to age, the body mass index, histology and FIGO stage(P>0.05).②The operating time in group B was significantly shorter than that in group A. The blood loss was significantly litter in group B than in group A(P<0.05). Numbers of pelvic lymph nodes resected, time to normal defecation and residual urine showed no significant variation between the two groups(P>0.05).③The intra-and postoperative complication rates profoundly decreased in group B as compared with group A(P<0.05).④After a follow-up of 16~40 months, 2 patients had a recurrence, 1 patient died. Conclusion Laparoscopic radical hysterectomy and pelvic lymphadenectomy is a safe and feasible treatment for cervical cancer without decreasing survival. The learning curve of laparoscopic radical hysterectomy and pelvic lymphadenectomy is approximately 30 cases, surgical outcome is obviously improved after performing 30 cases of cervical cancer.