本文關(guān)鍵詞： 外陰鱗癌 腹股溝淋巴結(jié)清掃術(shù) 腹腔鏡 開放性　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:將外陰鱗癌手術(shù)治療中腹股溝淋巴結(jié)清掃術(shù)腹腔鏡與開放性手術(shù)進(jìn)行對(duì)比研究,分析外陰鱗癌腹腔鏡下腹股溝淋巴結(jié)清掃術(shù)(Video Endoscopic Inguinal Lymphadenectomy,VEIL)的臨床療效及經(jīng)濟(jì)學(xué)指標(biāo),評(píng)價(jià)VEIL的臨床應(yīng)用價(jià)值及可推廣性。方法:通過病案管理系統(tǒng),回顧性分析2011年10月至2016年10月在運(yùn)城市中心醫(yī)院、長(zhǎng)治醫(yī)學(xué)院附屬和平醫(yī)院、山西省腫瘤醫(yī)院三家醫(yī)院39例外陰鱗癌患者,其中15例患者(ⅠA期5例,ⅠB期5例,Ⅱ期1例,Ⅲ期4例)行VEIL+外陰廣泛切除術(shù)(Radical Vulvectomy,RV),列為腹腔鏡組;24例患者(ⅠA期5例,ⅠB期7例,Ⅱ期7例,Ⅲ期4例,外陰腫物切除術(shù)后復(fù)發(fā)1例)行開放式腹股溝淋巴結(jié)清掃術(shù)(Open Lymphadenectomy,OPL)+RV,列為開放式組。所有納入患者術(shù)前外陰活組織檢查或腫物切除后均經(jīng)病檢確診為外陰鱗癌。腹腔鏡組和開放式組患者的年齡(歲)為(58.20±7.18)vs.(55.83±7.12);身高(cm)為(158.47±5.78)vs.(159.46±4.44);體重(kg)為(61.60±10.68)vs.(60.04±5.87)�；仡櫺苑治鰞山M患者總住院天數(shù)、術(shù)后住院天數(shù)、手術(shù)時(shí)間、術(shù)中出血量、分別清掃左右側(cè)淋巴結(jié)數(shù)目、術(shù)后引流管放置天數(shù)、總住院費(fèi)用、手術(shù)費(fèi)、麻醉費(fèi)、術(shù)后相關(guān)費(fèi)用、術(shù)后并發(fā)癥發(fā)生率、復(fù)發(fā)轉(zhuǎn)移情況、隨訪情況。采用SPSS19.0中χ2檢驗(yàn)和獨(dú)立樣本t檢驗(yàn)對(duì)所獲得的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。結(jié)果:兩組患者均成功實(shí)施了腹股溝淋巴結(jié)清掃術(shù)+外陰廣泛切除術(shù);兩組患者術(shù)前臨床FIGO分期和年齡、身高、體重差異均無統(tǒng)計(jì)學(xué)意義。腹腔鏡組與開放式組相比,結(jié)果如下:1.住院相關(guān)指標(biāo):腹腔鏡組住院總天數(shù)(d)(19.07±5.19 vs.23.58±6.83,P=0.035)、術(shù)后住院天數(shù)(d)(13.13±2.80 vs.16.29±4.53,P=0.021)短于開放式組,差異均有統(tǒng)計(jì)學(xué)意義。2.手術(shù)相關(guān)指標(biāo):腹腔鏡組與開放式組手術(shù)時(shí)間(min)(159.38±48.39 vs.153.13±28.26,P=0.654)、左側(cè)(7.13±3.72 vs.8.50±4.04,P=0.297)或右側(cè)(8.20±4.25 vs.7.67±3.53,P=0.674)切除淋巴結(jié)的數(shù)目等差異均無統(tǒng)計(jì)學(xué)意義;而術(shù)中出血量(ml)(57.33±37.31 vs.95.42±54.37,P=0.023)、術(shù)后引流管放置時(shí)間(d)(27±2.09 vs.11.88±3.84,P=0.009)差異有統(tǒng)計(jì)學(xué)意義。3.術(shù)后并發(fā)癥情況:術(shù)后總并發(fā)癥(近期并發(fā)癥:腹股溝區(qū)皮瓣壞死、傷口感染、傷口裂開、淋巴囊腫和遠(yuǎn)期并發(fā)癥:下肢淋巴水腫、淋巴漏)發(fā)生率(20.0%vs.29.2%,P=0.026)差異有統(tǒng)計(jì)學(xué)意義。4.術(shù)后病理資料及復(fù)發(fā)情況:術(shù)后陽性淋巴結(jié)例數(shù)(3例vs.5例,P=0.950)無統(tǒng)計(jì)學(xué)意義;腹腔鏡組有1例經(jīng)下肢通路置鏡孔處復(fù)發(fā)轉(zhuǎn)移(1/15,6.67%);開放式組有3例復(fù)發(fā),其中2例為外陰局部復(fù)發(fā),1例為右側(cè)腹股溝區(qū)復(fù)發(fā)(3/24,12.5%)。5.經(jīng)濟(jì)學(xué)指標(biāo):腹腔鏡組住院總費(fèi)用(元)(20589.02±3874.83 vs.25141.19±5104.93,P=0.005)、手術(shù)費(fèi)用(元)(4443.33±254.32 vs.3406.67±214.73,P0.001)、術(shù)后相關(guān)費(fèi)用(元)(5094.42±1391.87 vs.9495.14±3074.21,P0.001)均少于開放式組,具有統(tǒng)計(jì)學(xué)意義;麻醉費(fèi)用(元)(1292.00±352.28 vs.1212.63±134.42,P=0.324)無明顯差別。對(duì)所有患者進(jìn)行2個(gè)月的隨訪,期間兩組患者術(shù)后均未出現(xiàn)因外陰鱗癌復(fù)發(fā)死亡情況。結(jié)論:1.腹腔鏡手術(shù)可以達(dá)到跟開放性手術(shù)一樣控瘤效果,在手術(shù)時(shí)間、清掃淋巴結(jié)數(shù)目方面與開放式手術(shù)相當(dāng),在術(shù)中出血量、術(shù)后引流管放置時(shí)間、術(shù)后住院天數(shù)及術(shù)后并發(fā)癥的發(fā)生率等均優(yōu)于開放性手術(shù);2.VEIL對(duì)外陰鱗癌患者有更好的經(jīng)濟(jì)學(xué)效益;3.對(duì)于外陰鱗癌的手術(shù)治療,VEIL是一種可行的手術(shù)方式,值得推廣;4.對(duì)于術(shù)后遠(yuǎn)期復(fù)發(fā)情況,仍需要長(zhǎng)期的隨訪進(jìn)行大數(shù)據(jù)的對(duì)比研究。
[Abstract]:Objective: surgical treatment of vulvar squamous cell carcinoma of abdominal inguinal lymph node dissection in laparoscopic and open surgery for comparative study, analysis of squamous cell carcinoma of vulva of laparoscopic inguinal lymph node dissection (Video Endoscopic Inguinal Lymphadenectomy, VEIL) the clinical efficacy and economic indicators, to evaluate the clinical value of VEIL and replicability. Methods: the medical records management system, a retrospective analysis from October 2011 to October 2016 in Yuncheng Central Hospital, the affiliated Heping Hospital of Changzhi Medical College, Shanxi Provincial Tumor Hospital, three hospitals in 39 cases of vulvar squamous cell carcinoma patients, including 15 patients (5 cases, 5 cases of type A, type B 1 cases, stage II III in 4 cases) underwent VEIL+ resection of vulva (Radical Vulvectomy, RV), as the laparoscopic group; 24 patients (1 cases recurred in 5 cases, type A type B in 7 cases, 7 cases of stage II, 4 cases of stage III vulvar tumor resection) underwent open inguinal lymph node Sweep operation (Open Lymphadenectomy, OPL +RV), as the open group. All patients in preoperative vulvar biopsy or tumor resection were confirmed by pathological examination confirmed the diagnosis of vulvar squamous cell carcinoma. The laparoscopic group and open group of patients age (years) for (58.20 + 7.18) vs. (55.83 + 7.12) height; (CM) for (158.47 + 5.78) vs. (159.46 + 4.44); weight (kg) for (61.60 + 10.68) vs. (60.04 + 5.87). A retrospective analysis of two patients total hospitalization, postoperative hospitalization time, operation time, intraoperative blood loss, number of lymph nodes dissection of left and right sides respectively. Days after drainage tube placement, the total cost of hospitalization, operation fee, anesthetic fee, postoperative related costs, the incidence of postoperative complications, recurrence and metastasis, followed by SPSS19.0 in the 2. Chi square test and independent sample t test to obtain the data for statistical analysis. Results: two patients were successfully implemented. Inguinal lymph node dissection + vulva Wide excision; two groups of patients with clinical FIGO stage and age, height, weight. There were no significant differences in the laparoscopic group and open group, the results are as follows: 1. hospital related indicators: total length of hospital stay in laparoscopic group (d) (19.07 + 5.19 vs.23.58 + 6.83, P=0.035), postoperative hospital stay (d (vs.16.29) 13.13 + 2.80 + 4.53, P=0.021) shorter than the open group, the relevant indicators showed significant differences in.2. surgery: laparoscopic group and open surgery group (min) time (159.38 + 48.39 vs.153.13 + 28.26, P=0.654), left (7.13 + 3.72 vs.8.50 + 4.04, P=0.297 (8.20) or right + 4.25 vs.7.67 + 3.53 P=0.674), the number of lymph nodes removed, there were no significant differences; and the amount of bleeding (ML) (57.33 + 37.31 vs.95.42 + 54.37, P=0.023), postoperative drainage tube placement time (d) (27 + 2.09 vs.11.88 + 3.84, P=0.009) with statistically significant difference.3. after the operation In case of total postoperative complications (complications: groin flap necrosis, wound infection, wound dehiscence, lymphatic cyst and long-term complications: lower extremity lymphedema, lymph leakage) incidence rate (20.0%vs.29.2%, P=0.026) there was a significant difference between the.4. postoperative pathological data and recurrence of postoperative lymph node positive cases (3 cases of vs.5 patients, P=0.950) had no statistical significance; 1 cases in laparoscopic group by lower extremity pathway of a mirror hole recurrence (1/15,6.67%); the open group there were 3 cases of recurrence, including 2 cases of local recurrence of vulva, 1 cases of right inguinal region recurrence (3/24,12.5%).5. economic indicators: total laparoscopic group the cost (yuan) (20589.02 + 3874.83 vs.25141.19 + 5104.93, P=0.005), operation cost (yuan) (4443.33 + 254.32 vs.3406.67 + 214.73, P0.001), postoperative related costs (yuan) (5094.42 + 1391.87 + 3074.21 vs.9495.14, P0.001) were less than the open group, with the Statistical significance; the cost of anesthesia (yuan) (1292 + 352.28 vs.1212.63 + 134.42, P=0.324). There was no significant difference between the 2 months of follow-up for all patients during the two groups of patients were not due to recurrence of vulvar squamous cell carcinoma death. Conclusion: laparoscopic surgery can reach 1. with open surgery as tumor control effect and in the time of operation, the number of lymph nodes with open surgery, the intraoperative bleeding volume, postoperative drainage tube time, postoperative hospital stay and postoperative complications were superior to open surgery; 2.VEIL external vulvar squamous cancer patients have better economic benefits; 3. for the surgical treatment of vulva squamous cell carcinoma, VEIL is a feasible operation, worthy of promotion; 4. for the recurrence after operation, still need long-term follow-up study of big data.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.35

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