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目的探讨腹腔镜手术治疗肥胖患者早期子宫内膜癌的可行性及临床效果。方法 2003年8月～2009年10月采用腹腔镜辅助下经阴道子宫切除术治疗17例体重指数≥30的Ⅰ期子宫内膜癌,对于临床分期BⅠ、ⅠC期患者同时淋巴结取样。结果手术时间(215±50)min,术中出血量(231±88)ml,肠功能恢复时间(40±10)h,术后住院(8.2±1.1)d。术中1例损伤膀胱,1例损伤肠道,经镜下修补处理后未引起临床后果;1例因合并糖尿病手术穿刺口部位术后1周出现脂肪液化;1例腹壁穿刺孔出现皮下淤血,经过延长换药时间及微波物理治疗后好转。16例随访3年存活,1例术后13个月阴道残端复发次年死于全身转移。结论在一定腹腔镜基本技能基础上,肥胖患者早期子宫内膜癌不再是腹腔镜手术的相对禁忌证。
Objective To investigate the feasibility and clinical effect of laparoscopic surgery for early endometrial cancer in obese patients. Methods From August 2003 to October 2009, 17 cases of stage Ⅰ endometrial carcinoma with body mass index ≥30 were treated with laparoscopic assisted transvaginal hysterectomy. Meanwhile, lymph node samples were taken from patients with clinical stage Ⅰ B and stage Ⅰ C. Results The operative time (215 ± 50) min, intraoperative blood loss (231 ± 88) ml, intestinal function recovery time (40 ± 10) h, postoperative hospital stay (8.2 ± 1.1) d. 1 case of injury to the bladder, 1 case of damage to the intestine, after the repair by the mirror did not cause clinical consequences; 1 case of diabetic surgery puncture site 1 week after the occurrence of fat liquefaction; 1 case of abdominal puncture hole subcutaneous congestion, After prolonged dressing time and microwave physical therapy improved. Sixteen patients were followed up for 3 years, and one patient died of systemic metastasis in the following year after 13 months. Conclusion Based on the basic skills of laparoscopy, early endometrial cancer in obese patients is no longer the relative contraindication of laparoscopic surgery.