本文關鍵詞： 無氣腹腹腔鏡 宮頸癌 中老年 廣泛子宮切除 血流動力學穩(wěn)定　出處：《中國微創(chuàng)外科雜志》2017年04期 　論文類型：期刊論文

【摘要】：目的探討無氣腹腹腔鏡治療中老年宮頸癌患者的安全性及臨床應用價值。方法回顧性分析2014年6月~2015年10月年齡50歲的腹腔鏡宮頸癌根治術50例臨床資料,其中無氣腹手術24例,氣腹手術26例,比較2組氣腹前、術中60 min時平均動脈壓(mean arterial pressure,MAP)、心率(heart rate,HR)、吸氣峰壓(peak inspiratory pressure,PIP)、呼氣末CO2分壓(P_(ET)CO_2),以及手術時間、術中出血量、清掃淋巴結數目、切除陰道壁長度、住院費用、肛門排氣時間、術后住院時間、并發(fā)癥等指標。結果無氣腹組術中MAP、PIP、P_(ET)CO_2、HR與術前無統(tǒng)計學差異(P0.05);氣腹組術中MAP、PIP、P_(ET)CO_2較術前明顯升高(t=-6.669、-7.636、-4.387,P均=0.000),HR無統(tǒng)計學差異(t=-1.443,P=0.161)。2組手術時間、術中出血量、清掃淋巴結數、切除陰道壁長度無統(tǒng)計學差異(P0.05)。無氣腹組肛門排氣時間、術后住院時間、住院費用均明顯少于氣腹組[(2.0±0.6)d vs.(2.5±0.5)d,t=-2.886,P=0.006;(7.4±1.3)d vs.(8.2±1.4)d,t=-2.072,P=0.044;(2.0±0.6)萬元vs.(2.5±0.5)萬元,t=-3.853,P=0.000]。2組均無術中并發(fā)癥發(fā)生,術后淋巴潴留囊腫分別為17%(4/24)、19%(5/26),無統(tǒng)計學差異(χ~2=0.000,P=1.000)。結論無氣腹腹腔鏡宮頸癌根治術避免氣腹對人體血流動力學的影響,術中呼吸循環(huán)系統(tǒng)穩(wěn)定,術后腸道功能恢復快,住院時間短,可達到腹腔鏡宮頸癌手術同樣的根治效果,中老年患者接受無氣腹腹腔鏡宮頸癌根治術是安全可行的。
[Abstract]:Objective to evaluate the safety and clinical value of pneumoperitoneal laparoscopy in the treatment of cervical cancer in middle-aged and elderly patients. Methods the clinical data of 50 patients with cervical cancer aged 50 years from June 2014 to October 2015 were retrospectively analyzed. There were 24 cases without pneumoperitoneum and 26 cases with pneumoperitoneum. The mean arterial pressure before pneumoperitoneum and 60 min after pneumoperitoneum were compared between the two groups. The mean arterial pressureMAPP, heart rate, peak peak inspiratory pressure, peak inspiratory pressurePIPP, end expiratory CO2 partial pressure (CO2), and the number of dissected lymph nodes were compared between the two groups before pneumoperitoneum, operation time, intraoperative blood loss and the number of lymph nodes dissected. Length of vaginal wall, cost of hospitalization, time of anal exhaust, length of stay after operation, Results in the pneumoperitoneum group, there was no significant difference in MAPPIPP / PSP and ETCO _ 2 HR between before and after pneumoperitoneum (P < 0.05), but in pneumoperitoneum group, MAPPIPP _ P _ (ETCO _ 2) was significantly higher than that before pneumoperitoneum, and there was no significant difference in blood loss and lymph node number during operation between the two groups (P = 0.000, P < 0.05, P < 0.05), and the number of lymph nodes dissected during operation in the pneumoperitoneum group (P < 0.05), but there was no significant difference between the two groups in blood loss and lymph node dissection in the pneumoperitoneum group (P < 0.05). There was no significant difference in the length of vaginal wall in excision group (P 0.05). The length of anal exhaust, the time of hospitalization and the cost of hospitalization in the group without pneumoperitoneum were significantly lower than those in the group of pneumoperitoneum [2. 0 鹵0. 6 days vs.(2.5 鹵0. 5 vs.(2.5 鹵2. 88 6 vs.(2.5 鹵0. 006 鹵1. 4 鹵1. 4 vs.(8.2 鹵1. 4 d vs.(8.2 鹵1. 7 2 鹵0. 07 2 鹵0. 04 鹵0. 04 鹵0. 60 000 vs.(2.5 鹵0. 5 000 vs.(2.5 鹵0. 5 000]. No intraoperative complications occurred in all the groups. There was no significant difference in postoperative lymphatic retention cysts (17 / 4 / 24 / 19 / 5 / 26). Conclusion Laparoscopic radical pneumoperitoneum can avoid the effect of pneumoperitoneum on hemodynamics of human body, the respiratory and circulatory system is stable during operation, the intestinal function recovers quickly after operation, and the hospitalization time is short. Laparoscopic cervical cancer surgery can achieve the same radical effect, the elderly patients undergoing pneumoperitoneum laparoscopic radical cervical cancer surgery is safe and feasible.
【作者單位】： 鄭州大學第一附屬醫(yī)院婦科;
【分類號】：R737.33

【參考文獻】

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