CAJ | 학술논문

目的分析子宫内膜癌不同手术方式患者的术后并发症,探讨子宫内膜癌腹膜后淋巴结清扫术的安全性.方法回顾性分析2006年5月至2012年4月间北京大学肿瘤医院妇科收治的219例子宫内膜癌患者的临床资料,其中行筋膜外全子宫加双附件切除者(TAH+ BSO组)65例,筋膜外全子宫加双附件切除及盆腔淋巴结清扫术者(PLX组)54例,筋膜外全子宫加双附件切除及盆腔、腹主动脉旁淋巴结清扫术者(PALX组)100例.总结并分析采用不同手术方式患者的手术情况以及并发症的发生情况.结果 TAH+ BSO组、PLX组和PALX组患者的手术时间分别为(114.84±6.45)min、(182.94±6.62) min和(188.27±5.77) min,TAH+ BSO组明显短于PLX组和PALX组(P＜0.001).TAH+ BSO组、PLX组和PALX组患者的出血量分别为(222.97±38.42)ml、(311.80±21.62)ml和(391.51±53.20)ml,TAH+ BSO组明显少于PLX组和PALX组(P =0.009).子宫内膜癌腹膜后淋巴结清扫术后(PLX组和PALX组)最常见的并发症为下肢水肿,发生率为31.8％;其次为淋巴囊肿,发生率为27.3％.PALX组与PLX组比较,肠梗阻的发生率明显增加(P =0.001),但下肢水肿、淋巴囊肿及深静脉血栓的发生率差异均无统计学意义(均P＞0.05).结论腹膜后淋巴结清扫术术后并发症的发生率虽较单纯全子宫双附件切除术有所增加,但仍在可接受的范围内.在临床工作中,需选择合适的适应证以降低术后并发症的发生.
목적 분석자궁내막암불동수술방식환자적술후병발증,탐토자궁내막암복막후림파결청소술적안전성.방법 회고성분석2006년5월지2012년4월간북경대학종류의원부과수치적219례자궁내막암환자적림상자료,기중행근막외전자궁가쌍부건절제자(TAH+ BSO조)65례,근막외전자궁가쌍부건절제급분강림파결청소술자(PLX조)54례,근막외전자궁가쌍부건절제급분강、복주동맥방림파결청소술자(PALX조)100례.총결병분석채용불동수술방식환자적수술정황이급병발증적발생정황.결과 TAH+ BSO조、PLX조화PALX조환자적수술시간분별위(114.84±6.45)min、(182.94±6.62) min화(188.27±5.77) min,TAH+ BSO조명현단우PLX조화PALX조(P＜0.001).TAH+ BSO조、PLX조화PALX조환자적출혈량분별위(222.97±38.42)ml、(311.80±21.62)ml화(391.51±53.20)ml,TAH+ BSO조명현소우PLX조화PALX조(P =0.009).자궁내막암복막후림파결청소술후(PLX조화PALX조)최상견적병발증위하지수종,발생솔위31.8％;기차위림파낭종,발생솔위27.3％.PALX조여PLX조비교,장경조적발생솔명현증가(P =0.001),단하지수종、림파낭종급심정맥혈전적발생솔차이균무통계학의의(균P＞0.05).결론 복막후림파결청소술술후병발증적발생솔수교단순전자궁쌍부건절제술유소증가,단잉재가접수적범위내.재림상공작중,수선택합괄적괄응증이강저술후병발증적발생.
Objective To analyze the postoperative complications in patients with endometrial carcinoma undergoing surgical operation in different modes and to explore the surgical safety of retroperitoneal lymph node dissection.Methods Two hundred and nineteen patients with endometrial cancer treated in our hospital between May 2006 and April 2012 were included in this study.Their clinicopathological data were retrospectively analyzed.Among them,65 patients received total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO group),54 patients received TAH and BSO and pelvic lymph node dissection (PLX group),and 100 patients received TAH and BSO and PLX and para-aortic lymph node dissection (PALX group).The surgical procedures and postoperative complications in different operation modes were analyzed.Results The operation time was (114.84 ± 6.45) min in the TAH + BSO group,(182.94 ±6.62) min in the PLX group,and (188.27 ±5.77) min in the PALX group.The operation time in the TAH + BSO group was significantly shorter than that in the PLX and PALX group (P ＜0.001).The amount of blood loss was (222.97 ± 38.42) ml in the TAH + BSO group,(311.80 ± 21.62) ml in the PLX group,and (391.51 ±53.20) ml in the PALX group,respectively.The amount of blood loss in the TAH +BSO was significantly less than that in the PLX and PALX group (P =0.009).Lymphedema of the lower extremities was the most frequent complication of retroperitoneal lymph node dissection and the incidence rate was 31.8％.Lymphocyst was the second frequent complication,with an incidence rate of 27.3％.The incidence rate of ileus in the PALX group was significantly higher than that in the PLX group (P =0.001).There were no significant differences in the incidence rate of lymphedema,lymphocyst and deep vein thrombosis between the PALX and PLX groups (P ＞ 0.05).Conclusions Retroperitoneal lymph node dissection is an acceptable operation mode,although slightly increasing the incidence of ileus,compared with the TAH + BSO group.It is needed to choose appropriate indication in order to decrease the postoperative complications.