本文選題：子宮內(nèi)膜癌 + 腹主動(dòng)脈旁淋巴結(jié)切除術(shù)��； 參考：《實(shí)用婦產(chǎn)科雜志》2015年03期

【摘要】：目的:探討腹腔鏡下腹主動(dòng)脈旁淋巴結(jié)切除在子宮內(nèi)膜癌診治中的應(yīng)用價(jià)值及安全性、可行性。方法:選擇2010年3月至2014年3月子宮內(nèi)膜癌患者89例,其中,行腹腔鏡下腹主動(dòng)脈旁淋巴結(jié)切除手術(shù)50例(腹腔鏡組),傳統(tǒng)開腹腹主動(dòng)脈旁淋巴結(jié)切除手術(shù)39例(開腹組),比較兩組圍手術(shù)期情況、術(shù)中及術(shù)后并發(fā)癥、預(yù)后,統(tǒng)計(jì)分析淋巴結(jié)轉(zhuǎn)移患者臨床病理特征。結(jié)果:腹腔鏡組和開腹組患者在切除的淋巴結(jié)數(shù)目上差異無統(tǒng)計(jì)學(xué)意義(P0.05),腹腔鏡組較開腹組腹主動(dòng)脈旁淋巴結(jié)切除出血量少、術(shù)后病率低、術(shù)后肛門排氣時(shí)間早、術(shù)后住院時(shí)間短,但切除腹主動(dòng)脈旁淋巴結(jié)時(shí)間長(zhǎng)于開腹組,兩組比較差異均有統(tǒng)計(jì)學(xué)意義(P0.01,P0.05)。腹腔鏡組與開腹組在術(shù)中腔靜脈損傷、術(shù)后尿潴留、淋巴囊腫、深靜脈血栓、肺動(dòng)脈栓塞發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05),而開腹組切口裂開4例,腹腔鏡組無切口裂開,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后發(fā)現(xiàn)盆腔和(或)腹主動(dòng)脈旁淋巴結(jié)轉(zhuǎn)移共8例,除術(shù)前1例患者發(fā)現(xiàn)臍部癌轉(zhuǎn)移診斷為ⅣB期和1例患者磁共振成像提示盆腔淋巴結(jié)腫大癌轉(zhuǎn)移診斷ⅢC1期與術(shù)后病理診斷相同外,其余6例分期均較術(shù)前升高。兩組術(shù)后隨訪:開腹組復(fù)發(fā)2例,其中1例死亡;腹腔鏡組復(fù)發(fā)1例后死亡,均為晚期子宮內(nèi)膜癌患者。結(jié)論:腹主動(dòng)脈旁淋巴結(jié)切除是子宮內(nèi)膜癌規(guī)范化診治的重要組成部分,在對(duì)子宮內(nèi)膜癌患者準(zhǔn)確分期、制定精確術(shù)后診治方案,改善預(yù)后方面作用是肯定的,腹腔鏡下腹主動(dòng)脈旁淋巴結(jié)切除手術(shù)安全可行,優(yōu)于傳統(tǒng)開腹手術(shù)。
[Abstract]:Objective: To investigate the value and safety of laparoscopic inferior abdominal aortic lymph node resection in the diagnosis and treatment of endometrial carcinoma. Methods: 89 patients with endometrial carcinoma from March 2010 to March 2014 were selected, including 50 cases of laparoscopic inferior abdominal aortic lymph node resection (laparoscopy group) and traditional open abdominal aorta lymph nodes. 39 cases (open group), compared two groups of perioperative conditions, intraoperative and postoperative complications, prognosis, statistical analysis of the clinicopathological features of patients with lymph node metastasis. Results: there was no significant difference in the number of lymph nodes in the laparoscopic group and the open group (P0.05), and the laparoscopic group was compared with the open abdominal aorta lymph node excision. Less bleeding, low postoperative morbidity, early postoperative anus exhaust time and short hospital stay, but the time for the resection of the para aortic lymph nodes was longer than that in the open group. The two groups were statistically significant (P0.01, P0.05). The laparoscopic and open group were injured in the intraoperative vena cava, postoperative urinary retention, lymphatic cysts, deep venous thrombosis, pulmonary embolism. There was no significant difference in the rate of birth (P0.05), but in the open group, 4 cases were split, and the two groups had no significant difference (P0.05). There were 8 cases of pelvic and / or abdominal lymph node metastases in the pelvic and / or abdominal aorta after the operation. The diagnosis of the metastatic carcinoma of the umbilicus in the 1 patients before the operation was the fourth B phase and 1 patients with magnetic resonance imaging. The diagnosis of metastatic carcinoma of the pelvic lymph node with tumor metastasis was the same as that of the postoperative pathological diagnosis, the other 6 cases were higher than those before the operation. Two groups were followed up after operation: 2 cases were recurrent in the open group, 1 of them died, and 1 cases died after the laparoscopy group, all were advanced endometrium cancer patients. Conclusion: abdominal aortic lymph node resection is the normalization of endometrial carcinoma. The important part of the diagnosis and treatment is affirmative in the accurate staging of patients with endometrial cancer, the formulation of accurate postoperative diagnosis and treatment scheme, and the improvement of the prognosis. The laparoscopic inferior abdominal aortic lymph node resection is safe and feasible, which is superior to the traditional laparotomy.

【作者單位】： 揚(yáng)州大學(xué)附屬泰興醫(yī)院;南京大學(xué)醫(yī)學(xué)院附屬鼓樓醫(yī)院;
【基金】：江蘇省衛(wèi)生廳專項(xiàng)科研基金(編號(hào):YG201302)
【分類號(hào)】：R737.33

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本文編號(hào)：1793993