刘立峰,
王娇,
金仙玉^,
大连市中心医院 妇产科, 辽宁 大连 116003

详细信息 作者简介: 刘立峰(1971-), 男, 副主任医师。E-mail:liulifeng2008@hotmail.com



通讯作者: 金仙玉, 教授。E-mail:jinxy614@163.com 中图分类号: R737.31


摘要:目的探讨腹腔镜在早期卵巢上皮性癌全面分期手术中的应用效果。方法回顾性分析大连市中心医院2010年1月至2019年12月收治的81例早期卵巢上皮性癌（Ⅰ~Ⅱ期）患者的临床资料，根据手术方式分为腹腔镜组（n=49）和开腹组（n=32），比较两组的手术时间、术中出血量、术中肿瘤破裂、术中输血、术中脏器损伤、切除淋巴结数目、术后排气时间、术后住院天数、术后下地活动时间、术后抗生素使用时间、术后首次化疗时间、术后止痛剂的使用、术后感染、术后切口愈合不良、术后淋巴囊肿情况等，分析腹腔镜中转开腹原因，并比较两组复发情况。结果腹腔镜组和开腹组相比术中出血明显减少，术后排气时间、住院时间均明显缩短，术后下地活动时间亦明显缩短（P < 0.05）。两组手术时间、术中肿瘤破裂、术中输血、术中脏器损伤、淋巴结切除数量、术后抗生素使用时间、术后首次化疗时间、术后并发症发生情况等差异无显著性意义（P>0.05）。腹腔镜中转开腹手术12例，占24.5%，原因主要为肿瘤大、粘连致密造成操作空间狭小影响术野及镜下操作。腹腔镜组8例复发，开腹组4例复发，两组复发率比较差异无显著性意义（P>0.05）。结论腹腔镜早期卵巢上皮性癌全面分期手术是安全、可行的，同时具有术中出血少、术后排气时间短、住院日短、术后下地活动时间短等优势。但对于肿物大、与周围脏器组织粘连严重者，建议选择开腹手术为宜。
关键词: 早期卵巢上皮性癌/
腹腔镜/
开腹手术/
全面分期手术


Abstract:ObjectiveTo investigate efficiency of laparoscopy in comprehensive surgical staging of early-stage epithelial ovarian cancer (EOC).MethodsTotally 81 patients with EOC (Stage Ⅰ-Ⅱ), who underwent comprehensive surgical staging at Dalian Municipal Central Hospital from Jan.2010 to Dec.2019, were retrospectively analyzed. The patients were divided into two groups, undergoing either laparoscopic surgery (n=49) or laparotomic surgery (n=32). The operation time, intraoperative blood transfusion, intraoperative tumor rupture, intraoperative blood transfusion, intraoperative injury of organs, number of dissected pelvic lymph nodes, gastrointestinal-function recovery time, postoperative hospital stay, postoperative movement recovery time, postoperative antibiotic usage, beginning of the first cycle chemotherapy, anodyne usage, postoperative complications such as infection, poor incision healing and lymphocystis, reason of fail in laparoscopic surgery, and recurrence of disease were collected and analyzed.ResultsCompared with laparotomic group, laparoscopic group had less intraoperative blood loss, shorter gastrointestinal-function recovery time, postoperative hospital stay, and postoperative movement recovery time (P < 0.05). There were no significant differences in the mean operation time, intraoperative tumor rupture, intraoperative blood transfusion, intraoperative injury of organs, number of dissected pelvic lymph nodes, antibiotic usage time, beginning of the first cycle chemotherapy and postoperative complications between laparoscopic and laparotomic groups (P>0.05). There were 12 cases (24.5%) changed to laparotomic surgery in laparoscopic group due to narrow operative space, large tumor size and comprehensive pelvic adhesion. There were 8 and 4 cases of recurrence in laparoscopic and laparotomic group respectively, which had no significant difference (P>0.05).ConclusionIt is safe and feasible to carry out comprehensive laparoscopic staging of early-stage epithelial ovarian cancer, which reduces intraoperative blood loss, and shortens gastrointestinal-function recovery time, postoperative hospital stay, and postoperative movement recovery time. It is better to perform laparotomic surgery for patients with big tumor and wide pelvic adhesion.
Keywords:early-stage epithelial ovarian cancer/
laparoscopy/
laparotomy/
comprehensive staging surgery

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