【摘要】：目的比較腹腔鏡下根治性子宮切除術(shù)（laparoscopic radicalhysterectomy，LRH）與經(jīng)腹根治性子宮切除術(shù)（radical abdominalhysterectomy，RAH）治療宮頸癌的療效，探討腹腔鏡下根治性子宮切除術(shù)治療宮頸癌的優(yōu)越性、安全性及可行性。 方法回顧性分析2012年1月至2013年7月重慶醫(yī)科大學(xué)附屬第一醫(yī)院行LRH的63例宮頸癌患者的病歷資料（腹腔鏡組），，抽取同期行RAH的74例宮頸癌病例作為對照（開腹組）。比較兩組患者的年齡、分期、組織類型、手術(shù)時間、術(shù)中出血量、術(shù)中切除淋巴結(jié)數(shù)目、術(shù)中切除陰道長度、切除主韌帶長度、切除骶韌帶長度、輸血例數(shù)、術(shù)中及術(shù)后并發(fā)癥（包括術(shù)中血管損傷、腸道損傷、輸尿管損傷、膀胱損傷，術(shù)后尿路感染、尿儲留、淋巴囊腫、切口感染、切口愈合不良、腸根阻）、手術(shù)預(yù)后等。 結(jié)果兩組的手術(shù)時間、切除淋巴結(jié)數(shù)目、切除主骶韌帶長度、尿路感染例數(shù)相比較差異無統(tǒng)計學(xué)意義（P0.05）。腹腔鏡組術(shù)中出血量明顯少于開腹組（P 0.01），腹腔鏡組切除的陰道長度（3.34±0.45）cm大于開腹組的（3.17±0.36）cm，P 0.05，腹腔鏡組無輸血患者，與開腹組比較差異有統(tǒng)計學(xué)意義（P 0.05）。腹腔鏡組術(shù)中及術(shù)后并發(fā)癥發(fā)生共13例，開腹組41例，兩組差異有統(tǒng)計學(xué)意義（P 0.05），腹腔鏡組無一例發(fā)生切口感染、切口二期縫合，與開腹組比較，兩組差異有統(tǒng)計學(xué)意義（P 0.05），腹腔鏡組僅有1例膀胱損傷，兩組尿潴留、血管損傷、膀胱損傷、輸尿管損傷、腸道損傷、神經(jīng)損傷、腸根阻、下肢深靜脈血栓淋巴囊腫比較差異無統(tǒng)計學(xué)意義（P0.05）。 結(jié)論腹腔鏡下根治性子宮切除術(shù)較開腹手術(shù)具有手術(shù)視野清晰、創(chuàng)傷小，手術(shù)安全性高，出血量少，手術(shù)徹底，術(shù)后恢復(fù)快等優(yōu)點，對于手術(shù)治療宮頸癌具有重要的臨床應(yīng)用價值。
[Abstract]:Objective to compare the efficacy of laparoscopic radical hysterectomy (laparoscopic radicalhysterectomy,LRH) and transabdominal radical hysterectomy (radical abdominalhysterectomy,RAH) in the treatment of cervical cancer. Safety and feasibility. Methods from January 2012 to July 2013, the medical records of 63 patients with cervical cancer who were treated with LRH in the first affiliated Hospital of Chongqing Medical University (laparoscopic group) were analyzed retrospectively. 74 cases of cervical cancer treated with RAH were selected as control group (open group). Age, stage, histological type, operative time, intraoperative bleeding, number of lymph nodes removed, length of vagina, length of main ligament, length of sacral ligament, blood transfusion were compared between the two groups. Intraoperative and postoperative complications (including intraoperative vascular injury, intestinal injury, ureteral injury, bladder injury, postoperative urinary tract infection, urinary retention, lymphocyst, incision infection, wound healing, intestinal root obstruction), surgical prognosis, etc. Results there was no significant difference in the operation time, the number of lymph nodes, the length of sacral ligament and the number of urinary tract infection between the two groups (P0.05). The volume of intraoperative bleeding in the laparoscopic group was significantly lower than that in the open group (P0.01), and the vaginal length in the laparoscopic group was (3.34 鹵0.45) cm larger than that in the laparotomy group (3.17 鹵0.36) cm,P 0.05.There was no blood transfusion in the laparoscopic group. There was significant difference between the two groups (P 0.05). There were 13 cases of intraoperative and postoperative complications in the laparoscopic group and 41 cases in the open group (P 0.05). The difference between the two groups was statistically significant (P 0.05). There was only one case of bladder injury in the laparoscopic group. Urinary retention, vascular injury, bladder injury, ureteral injury, intestinal injury, nerve injury, intestinal root obstruction were observed in the two groups. There was no significant difference in lower extremity deep vein thrombosis lymphocysts (P0.05). Conclusion Laparoscopic radical hysterectomy has the advantages of clear visual field, less trauma, high safety, less bleeding, thorough operation and quick postoperative recovery. It has important clinical application value for surgical treatment of cervical cancer.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33

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