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目的分析腹腔镜下广泛性子宫切除术联合盆腔淋巴结清扫术不同阶段的手术效果,探讨腹腔镜下广泛性子宫切除术联合盆腔淋巴结清扫术的学习曲线。方法回顾性分析2007年7月~2009年11月由同一组妇科医师完成的60例腹腔镜下广泛性子宫切除术联合盆腔淋巴结清扫术的宫颈癌患者,按手术先后顺序分为两组(A、B),每组30例,比较两组手术时间、术中出血量、检出盆腔淋巴结数量、恢复排气时间、恢复正常排尿时间及并发症情况。结果①两组病例在年龄、体质量指数、组织病理学类型、临床分期方面比较,差异均无统计学意义(P>0.05);②B组平均手术时间明显短于A组,术中平均出血量明显少于A组,差异有统计学意义(P<0.05);两组病例在检出盆腔淋巴结数量、恢复排气时间、恢复正常排尿时间方面比较,差异无统计学意义(P>0.05);③A组手术并发症的发生率明显高于B组(P<0.05)。④随访16~40个月,2例患者复发,1例患者死亡。结论开展腹腔镜下广泛性子宫切除术及盆腔淋巴结清扫术是安全可行的,妇科手术医师行腹腔镜下宫颈癌根治术的学习曲线大约为30例,经过30例的手术操作,外科学结局明显改善。
Objective To analyze the operative effects of laparoscopic radical hysterectomy combined with pelvic lymphadenectomy at different stages and explore the learning curve of laparoscopic radical hysterectomy combined with pelvic lymph node dissection. Methods From July 2007 to November 2009, 60 patients with cervical cancer who underwent laparoscopic radical hysterectomy and pelvic lymphadenectomy performed by the same group of gynecologists were retrospectively divided into two groups (A , B), 30 cases in each group. The operation time, intraoperative blood loss, the number of pelvic lymph nodes, the recovery of exhaust time and the recovery of normal urination time and complications were compared between the two groups. Results ① There was no significant difference in age, body mass index, histopathological type and clinical stage between the two groups (P> 0.05). ② The average operation time in group B was significantly shorter than that in group A, mean intraoperative blood loss (P <0.05). There was no significant difference between the two groups in detecting the number of pelvic lymph nodes, restoring the exhaust time and returning to normal urination time (P> 0.05). ③ The incidence of surgical complications in group A was significantly higher than that in group B (P <0.05). The patients were followed up for 16 to 40 months. Two patients relapsed and one patient died. Conclusions The laparoscopic radical hysterectomy and pelvic lymphadenectomy are safe and feasible. The learning curve of laparoscopic radical mastectomy for gynecological surgeons is about 30 cases. After 30 cases of surgical operation, the surgical outcomes are obvious improve.