發(fā)布時(shí)間：2018-04-13 02:08

  本文選題：子宮內(nèi)膜癌 + 腹腔鏡手術(shù)��； 參考：《浙江大學(xué)》2016年碩士論文

【摘要】：研究背景和目的子宮內(nèi)膜癌是常見的婦科腫瘤之一,且發(fā)病率逐年上升。子宮內(nèi)膜癌早期即可有不規(guī)則陰道流血流液等癥狀,大部分子宮內(nèi)膜癌能夠在早期被發(fā)現(xiàn),且大多數(shù)都能靠手術(shù)達(dá)到治愈的目的,死亡率較低。目前對于子宮內(nèi)膜癌的手術(shù)方式主要有機(jī)器人輔助下腹腔鏡下手術(shù)、腹腔鏡下手術(shù)及常規(guī)剖腹手術(shù)三種,文獻(xiàn)研究顯示微創(chuàng)手術(shù)已在子宮內(nèi)膜癌的治療方面顯示出較大優(yōu)勢,但由于不同的醫(yī)療中心存在設(shè)備和技術(shù)的差異,在腹腔鏡手術(shù)和開腹手術(shù)的比較結(jié)果方面尚存在差異,本研究通過回顧性分析2006年2月至2016年2月在本院行腹腔鏡和開腹手術(shù)治療的早期子宮內(nèi)膜癌患者,對比腹腔鏡手術(shù)與開腹手術(shù)治療在各方面的差異和效果。研究方法回顧性分析2006年2月至2016年2月本院302例手術(shù)治療的子宮內(nèi)膜癌患者,選取其中行筋膜外子宮全切加雙側(cè)附件切除加盆腔及腹主動脈旁淋巴結(jié)清掃術(shù)的86例Ⅰ-Ⅱ期早期子宮內(nèi)膜癌,其中腹腔鏡組52例,開腹組34例,比較兩組的手術(shù)時(shí)間、術(shù)中出血量、術(shù)中并發(fā)癥、病理類型、淋巴結(jié)切除數(shù)量、術(shù)后住院時(shí)間、肛門排氣恢復(fù)時(shí)間、留置導(dǎo)尿時(shí)間及術(shù)后生存率等指標(biāo)。研究結(jié)果兩組患者術(shù)前的基本特征包括年齡、BMI、合并癥(高血壓、糖尿病)、FIGO分期之間無統(tǒng)計(jì)學(xué)差異(p0.05)。腹腔鏡組平均手術(shù)時(shí)間為(184.33±38.68)min,開腹組平均手術(shù)時(shí)間為(187.56±58.70)min,兩組手術(shù)時(shí)間無顯著性差異(P0.05),腹腔鏡組的術(shù)中出血量為40(20-50)ml,開腹組的術(shù)中出血量為200(100-262.5)ml,腹腔鏡組的術(shù)中出血量顯著少于開腹組,差異有顯著性(P0.01)。腹腔鏡組術(shù)中有1例發(fā)生術(shù)中輸尿管損傷(1.92%),無術(shù)中輸血,開腹組患者無術(shù)中輸尿管損傷,有2例術(shù)中輸血(5.88%)。腹腔鏡組的術(shù)后住院時(shí)間為(5.71±1.91)天,開腹組的術(shù)后住院時(shí)間為(8.88±2.79)天,腹腔鏡組術(shù)后住院時(shí)間較短,差異有顯著性(P0.01)；腹腔鏡組的住院費(fèi)用為(25174.99±4242.66)元,開腹組的住院費(fèi)用為(20351.73±3916.16)元,開腹組的住院費(fèi)用較少,差異有顯著性(P0.01)。腹腔鏡組切除淋巴結(jié)數(shù)量為(20.25±9.02)個(gè),開腹組切除淋巴結(jié)數(shù)量為(17.97±8.34),兩組相比無顯著性差異(P0.05)。腹腔鏡組術(shù)后肛門排氣時(shí)間為(2.25±0.56)天,開腹組術(shù)后肛門排氣時(shí)間為(3.41±0.86)天,腹腔鏡組術(shù)后肛門恢復(fù)排氣時(shí)間較短,差異有顯著性(P0.01)。腹腔鏡組術(shù)后留置導(dǎo)尿時(shí)間為(2.38±0.75)天,開腹組術(shù)后留置導(dǎo)尿時(shí)間為(3.76±1.13)天,腹腔鏡組術(shù)后留置導(dǎo)尿時(shí)間較短,差異有顯著性(P0.01)。腹腔鏡組的5年生存率分別為95.5%,開腹組的5年生存率分別為92.9%,兩組相比無顯著性差異(P0.05)。腹腔鏡組5年無瘤生存率為93.2%,開腹組5年無瘤生存率為89.3%,兩組相比無顯著性差異(P0.05)。研究結(jié)論本研究表明,腹腔鏡與開腹手術(shù)在早期子宮內(nèi)膜癌內(nèi)膜癌治療上療效相當(dāng),但腹腔鏡手術(shù)具有創(chuàng)傷小、術(shù)中出血少、術(shù)后患者恢復(fù)快及絕對生存率高等優(yōu)勢,其可作為子宮內(nèi)膜癌優(yōu)先的治療方法之一。
[Abstract]:Background and objective endometrial carcinoma is one of the most common gynecologic tumors, and the incidence rate is rising year by year. The early stage of endometrial carcinoma with irregular vaginal bleeding sap and other symptoms, most of endometrial cancer can be found in the early stage, and most of them can achieve the purpose of cure by surgery, mortality rate is low. The operation mode endometrial cancer mainly in robot assisted laparoscopic surgery, surgery and conventional laparotomy three laparoscopic, minimally invasive surgery has literature research shows that in the treatment of endometrial cancer has shown great advantages, but due to the differences in equipment and technology in different medical center, the results of the comparison of laparoscopic and open surgery of the hand there are still differences, this study through a retrospective analysis from February 2006 to February 2016 in the early stage of our hospital laparoscopic and open surgery in the treatment of endometrial cancer In contrast, laparoscopic surgery and open surgery for differences in various aspects and effects. Methods Retrospective analysis of treatment from February 2006 to February 2016 in our hospital 302 cases of patients with endometrial cancer, 86 cases of them underwent selected extrafascial total hysterectomy with bilateral oophorectomy and pelvic and paraaortic lymph node dissection II the early stage of endometrial carcinoma, 52 cases were treated with laparoscopic and laparotomy group 34 cases, compared two groups of operation time, intraoperative blood loss, intraoperative complications, pathological type, lymph node resection, postoperative hospitalization time, anal exhaust recovery time, rate of survival time and postoperative indwelling catheterization. The basic characteristics of the two groups of patients before surgery include age, BMI, comorbidities (hypertension, diabetes), no significant difference between FIGO staging (P0.05). The average operative time of laparoscopic group (184.33 + 38.68) min, the open group average 鎵嬫湳鏃墮棿涓，

本文編號：1742444