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目的探讨腹腔镜手术治疗子宫颈癌的临床疗效及其预后影响因素。方法回顾性分析1999年9月至2008年12月在佛山市第一人民医院接受腹腔镜手术治疗且资料完整的153例子宫颈癌患者的临床资料,观察近、远期疗效及手术并发症,并通过多因素Cox模型分析预后影响因素。结果153例患者中,鳞癌135例,腺癌11例,腺鳞癌5例,小细胞癌2例。FIGOⅠ期119例,Ⅱ期32例,Ⅲ期2例。5例Ia_1期患者行腹腔镜下全子宫切除术,148例拟行腹腔镜下广泛性子宫切除及盆腔淋巴结切除术的患者中,144例(97.3%)顺利完成腹腔镜手术治疗,术中脏器损伤发生率4.83%,平均手术时间、术中出血量、淋巴结切除数、术后肛门排气时间、停留尿管时间、住院时间分别为(253.82±68.14)min、(310.4±265.0)mL、(23.5±9.1)个、(2.13±0.53)d、(12.39±7.28)d、(14.35±7.91)d。术后病率9.03%,阴道残端感染率3.47%。截止2009年2月,中位随访时间35个月(2～104个月),1999年9月至2003年12月共23例,5年总体生存率61%,其中Ⅰ期、Ⅱ期分别为63%、50%;2004年1月至2008年12月共126例,4年总体生存率85%,其中Ⅰ期、Ⅱ期分别为90%、69%,两阶段比较差异有统计学意义。经多因素Cox模型分析发现,仅淋巴结有无转移一项与预后相关(OR=3.167,P<0.05)。结论腹腔镜手术治疗早期子宫颈癌具有创伤小、术后恢复快等微创优势,规范而成熟的腹腔镜手术操作是保障手术成功和手术效果的重要因素。
Objective To investigate the clinical efficacy and prognostic factors of laparoscopic surgery for cervical cancer. Methods The clinical data of 153 patients with cervical cancer who underwent laparoscopic surgery in Foshan First People’s Hospital from September 1999 to December 2008 were retrospectively analyzed. The short-term and long-term effects and complications were observed. Prognostic factors were analyzed by multivariate Cox model. Results Among the 153 patients, 135 were squamous cell carcinoma, 11 adenocarcinoma, 5 adenosquamous carcinoma and 2 small cell carcinoma. 119 cases of FIGO Ⅰ, 32 cases of stage Ⅱ, 2 cases of stage Ⅲ. Of the 5 patients with stage Ia_1 who underwent hysterectomy by laparoscopy and 148 patients who underwent laparoscopic radical hysterectomy and pelvic lymphadenectomy, 144 cases (97.3%) were successfully treated with laparoscopic surgery, The mean operative time, intraoperative blood loss, lymph node resection, postoperative anal exhaust time, stay catheterization time and hospital stay were (253.82 ± 68.14) min, (310.4 ± 265.0) mL, (23.5 ± 9.1), (2.13 ± 0.53) d, (12.39 ± 7.28) d, (14.35 ± 7.91) d respectively. Postoperative morbidity was 9.03%, vaginal stump infection rate was 3.47%. As of February 2009, the median follow-up time was 35 months (range 2-104 months). From September 1999 to December 2003, 23 patients had a median overall survival of 61% at 5 years, of which stage Ⅰ and stage Ⅱ were 63% and 50% respectively; 126 cases were from January 2004 to December 2008, and the 4-year overall survival rate was 85%, of which stage Ⅰ and Ⅱ were 90% and 69% respectively. There was significant difference between the two stages. Multivariate Cox model analysis found that only lymph node metastasis with a prognosis (OR = 3.167, P <0.05). Conclusions Laparoscopic surgery for early cervical cancer has the advantages of less trauma and faster recovery after operation. Standardized and mature laparoscopic operation is an important factor to ensure the success of operation and the effect of operation.