發(fā)布時(shí)間：2018-04-27 20:13

  本文選題：腹腔鏡 + 腹膜后淋巴結(jié)清掃術(shù)��； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：宮頸癌是發(fā)展中國家常見的惡性腫瘤之一,據(jù)WHO統(tǒng)計(jì),80%的新發(fā)病例都發(fā)生在發(fā)展中國家,其中的80%是中晚期患者。目前婦科腫瘤中卵巢癌和子宮內(nèi)膜癌均已采用病理分期,宮頸癌仍使用FIGO臨床分期,并未考慮淋巴結(jié)對(duì)預(yù)后的影響,很多臨床分期與手術(shù)分期的差異被報(bào)道。腹腔鏡具有放大,視野清晰,容易辨別解剖位置等特點(diǎn)。隨著腹腔鏡技術(shù)的普及,腹腔鏡下手術(shù)病理分期的有效性和安全性得到了肯定。在手術(shù)方式的選擇上,1996年首次開展腹腔鏡下腹膜外淋巴結(jié)清掃術(shù),它同時(shí)結(jié)合了腹腔鏡和腹膜外路徑的優(yōu)點(diǎn),直接降低了腸道損傷、腸道粘連的風(fēng)險(xiǎn)并降低住院治療的時(shí)間,對(duì)提高患者的生活質(zhì)量帶來極大的幫助。國外的婦瘤專家不斷對(duì)此技術(shù)進(jìn)行改良,并對(duì)腹腔鏡下腹膜后入路的可行性和安全性進(jìn)行探討。國內(nèi)研究較少。本研究分為二部分：1、腹腔鏡下腹膜后淋巴結(jié)清掃術(shù)在局部中晚期宮頸癌患者中可行性和安全性的系統(tǒng)評(píng)價(jià)。2、腹腔鏡下腹膜后淋巴結(jié)清掃術(shù)在局部中晚期宮頸癌患者中的初步臨床研究。 臨床數(shù)據(jù)均來自廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院婦瘤科。 目的進(jìn)行系統(tǒng)的文獻(xiàn)回顧對(duì)于腹腔鏡下腹膜后淋巴結(jié)清掃術(shù)對(duì)局部中晚期宮頸癌患者的治療提供了現(xiàn)有文獻(xiàn)的循證醫(yī)學(xué)證據(jù)。方法檢索CBM、 CENTRAL、MEDLINE、Cochrane library、EMBASE、CNKI數(shù)據(jù)庫中關(guān)于腹腔鏡下腹膜后淋巴結(jié)清掃術(shù)(Laparoscopic retroperitoneal lymph node dissection LRLD)治療局部中晚期宮頸癌(locally advanced cervical cancer LACC)患者的臨床資料,進(jìn)行相關(guān)文獻(xiàn)分析,探討LRLD應(yīng)用于LACC患者的安全性、可行性及臨床意義。結(jié)果12項(xiàng)研究符合納入標(biāo)準(zhǔn),RCT研究2項(xiàng),描述性研究10篇。宮頸癌亞組共入組727例病例,腹膜后組695例,經(jīng)腹膜組32例。從手術(shù)過程,手術(shù)效果,術(shù)后短期恢復(fù)情況,術(shù)后復(fù)發(fā)及長期預(yù)后等方面,對(duì)腹腔鏡下腹膜后淋巴結(jié)清掃術(shù)治療局部中晚期宮頸癌的可行性進(jìn)行評(píng)估與探討。為腹腔鏡下腹膜后淋巴結(jié)清掃術(shù)對(duì)局部中晚期宮頸癌患者的治療提供了有利的循證醫(yī)學(xué)證據(jù)。結(jié)論目前腹腔鏡下腹膜后淋巴結(jié)清掃術(shù)手術(shù)切口小、術(shù)后腸道功能恢復(fù)快、飲食恢復(fù)快、住院時(shí)間短等優(yōu)點(diǎn)已基本得到認(rèn)可。但由于仍欠缺大規(guī)模病例的多中心RCT研究,局部及遠(yuǎn)處復(fù)發(fā)率以及長期預(yù)后包括5年生存期等仍欠缺大規(guī)模病例的多中心RCT研究。 目的探討腹腔鏡下腹膜后淋巴結(jié)清掃術(shù)(Laparoscopic retroperitoneal lymph node dissection LRLD)應(yīng)用在局部中晚期宮頸癌患者中的技術(shù)要點(diǎn)、可行性及其安全性。方法對(duì)廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院2013年03月至2014年03月收治的13例經(jīng)病理證實(shí)的局部中晚期(IIB-IVA)宮頸癌患者進(jìn)行腹腔鏡下經(jīng)腹膜外淋巴結(jié)清掃。對(duì)所得數(shù)據(jù)進(jìn)行可行性分析。結(jié)果1例手術(shù)在分離過程中腹膜破裂,C02氣體進(jìn)入腹腔內(nèi),無法維持腹膜外腔壓力,改腹膜內(nèi)手術(shù),余12例腹腔鏡下腹膜外淋巴結(jié)清掃術(shù)成功,手術(shù)治療的中位時(shí)間為230分鐘(130-359分鐘),術(shù)中出血量中位數(shù)50(20-350)m1。淋巴結(jié)取出總數(shù)為336個(gè),10(5-17)個(gè)腹主動(dòng)脈旁淋巴結(jié),和18(16-40)個(gè)盆腔淋巴結(jié)。11(91.7%)患者淋巴結(jié)轉(zhuǎn)移。并發(fā)癥為術(shù)后淋巴囊腫的形成,在充分引流后淋巴囊腫消失體溫降至正常,隨訪1-12個(gè)月,無復(fù)發(fā)及轉(zhuǎn)移病例。結(jié)論LRLD術(shù)式在技術(shù)上是安全,可行的,患者痛苦小,切口小,恢復(fù)快,縮短住院時(shí)間,減少失血量,減瘤的同時(shí)為后續(xù)放療野的確定提供了依據(jù),術(shù)后并發(fā)癥發(fā)生率低可以使患者日常生活迅速恢復(fù),后續(xù)輔助治療早期開始,提高了生活質(zhì)量。
[Abstract]:Cervical cancer is one of the most common malignant tumors in developing countries. According to WHO statistics, 80% of new cases occur in developing countries, and 80% of them are middle and late patients. At present, both ovarian and endometrial cancer in gynecologic tumors have been staging by pathological stages. Cervical cancer still uses FIGO clinical staging and does not consider the effect of lymph node on prognosis. The difference between clinical staging and surgical staging has been reported. Laparoscopy has the characteristics of magnification, clear vision, easy to distinguish the anatomical position. With the popularization of laparoscopy, the effectiveness and safety of the pathological stage of the laparoscopic operation are confirmed. In the choice of surgical methods, the laparoscopic inferior peritoneal lymph node dissection was first carried out in 1996. It also combines the advantages of laparoscopy and extraperitoneal route, which directly reduces the intestinal damage, the risk of intestinal adhesion and reduces the time of hospitalization. It is a great help to improve the quality of life of the patients. The foreign women's cancer experts continue to improve the technology and the feasibility and safety of the laparoscope underbelly. This study is divided into two parts. This study is divided into two parts: 1, a systematic evaluation of the feasibility and safety of laparoscopic hypogastric lymph node dissection in patients with locally advanced cervical cancer. A preliminary clinical study of laparoscopic hypogastric lymph node dissection in patients with locally advanced cervical cancer.
All the clinical data were from the Department of gynaecology and oncology, Affiliated Tumor Hospital of Guangxi Medical University.
Objective to provide a systematic literature review on the evidence of evidence-based medicine in the existing literature on the treatment of patients with locally advanced cervical cancer by laparoscopic hypogastric lymph node dissection. Methods CBM, CENTRAL, MEDLINE, Cochrane library, EMBASE, CNKI database on retroperitoneal lymph node dissection of abdominal endoscopy (Laparoscopic retr) Operitoneal lymph node dissection LRLD) in the treatment of patients with locally advanced cervical cancer (locally advanced cervical cancer LACC), the clinical data of patients with locally advanced cervical cancer LACC were analyzed, and the safety, feasibility and clinical significance of LRLD applied to LACC patients were discussed. Results 12 studies were included in the inclusion criteria, 2 studies, 10 descriptive studies. 727 cases, 695 Cases of retroperitoneal group and 32 cases of peritoneum group were included in the cancer subgroup. The feasibility of laparoscopic Subperitoneal lymphadenectomy for the treatment of locally advanced cervical cancer was evaluated and discussed from the operation process, the operation effect, the postoperative short-term recovery, the postoperative recurrence and the long-term prognosis. It provides evidence of evidence-based medicine for the treatment of locally advanced cervical cancer. Conclusion the advantages of small incision, quick recovery of postoperative intestinal function, quick recovery of diet, short stay in hospital have been basically recognized by laparoscopic underbelly lymph node dissection, but there is still a lack of multicenter RCT study for large cases. Local and distant recurrence rates and long-term prognosis, including 5 year survival, are still lacking in large scale multicenter RCT studies.
Objective to investigate the technical points, feasibility and safety of the application of Laparoscopic retroperitoneal lymph node dissection LRLD (lymph node dissection LRLD) in patients with locally advanced cervical cancer. Methods 13 cases confirmed by pathology from 03 months to 03 months in the Cancer Hospital Affiliated to Guangxi Medical University were confirmed by pathology. 1 patients with advanced (IIB-IVA) cervical cancer underwent laparoscopic extraperitoneal lymph node dissection. Results the results of the data were analyzed. Results 1 cases were broken through peritoneum during the process of separation, C02 gas entered the abdominal cavity, the extraperitoneal pressure could not be maintained, peritoneal surgery was changed, and the remaining 12 cases of laparoscopic inferior abdominal lymph node dissection were successful. The median time of the operation was 230 minutes (130-359 minutes), the median 50 (20-350) m1. lymph nodes were removed, 10 (5-17) para aortic lymph nodes, and 18 (16-40) pelvic lymph nodes.11 (91.7%) lymph node metastasis. The complication was the formation of postoperative lymphatic cysts and the disappearance of lymphatic cysts after full drainage. The LRLD operation was technically safe, feasible, small pain, small incision, quick recovery, shorter hospital stay, less blood loss, reduction of blood loss, and a basis for the determination of subsequent radiotherapy field. The low incidence of postoperative complications could quickly restore the patient's daily life. In addition, subsequent adjuvant treatment started early and improved the quality of life.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33

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本文編號(hào)：1812149