O'Hanlan Katherine A, Huang Gloria Shining, Lopez Lisbeth, Garnier Anne-Caroline
Gynecologic Oncology Associates, Portola Valley, CA 94028, USA.
Gynecol Oncol. 2004 Apr;93(1):137-43. doi: 10.1016/j.ygyno.2003.12.020.
We studied patients undergoing adnexectomy with total laparoscopic hysterectomy (TLH) for ovarian pathology, over a 6-year period.
Chart abstraction, analyzed by ANOVA, Fisher's Exact Test with significance at P < 0.05, stratifying by body mass index (BMI, kg/m(2): ideal < 25; overweight 25-29.9; obese 30+).
Of 354 patients undergoing TLH, 90 cases had adnexal pathology: 69 complex masses, 16 BRCA1/2 mutations, 5 unstaged ovarian carcinomas; 48 having ideal BMI, 26 overweight, and 16 obese. Mean age (51 years) and parity (1.2 children) were similar between BMI groups. Thirty-four percent were nulliparous. All 90 underwent TLH, adnexectomy, washings; with 14 appendectomies, 5 lymphadenectomies, 3 node samplings, 6 omentectomies, 8 ureterolyses, and 1 Burch. Mean surgery duration (156 min), blood loss (152cc), and hospital stay (1.9 days) were similar across BMI groups. Mean nodal yield from each lymphadenectomy was 14, and 2.6 from sampling. Mean size of pelvic masses was 8 cm (range 3-19 cm). There were seven cases of ovarian carcinoma: 2 Stage IA, 1 IB, 2 IC, 1 IIC, 1 IIIB; 1 recurrent breast cancer, 16 adenofibromas, 15 endometriomas, 10 dermoids, and 41 serous/mucinous cystadenomas. Mean complication rate was 6.6% (ns): 1 seroma, 1 hematoma, 1 obstructive adhesions, and 3 urological injuries. All urological injuries were within the first third of patients.
TLH appears feasible for women with adnexal pathology regardless of BMI, in an oncological practice. This pilot data can facilitate guidelines for a randomized controlled trial of TLH with TAH and LAVH, and help surgeons avoid our early complications.
我们对6年间因卵巢病变接受全腹腔镜子宫切除术（TLH）及附件切除术的患者进行了研究。
通过方差分析、Fisher精确检验对病历进行分析，显著性水平为P < 0.05，按体重指数（BMI，kg/m²：理想体重<25；超重25 - 29.9；肥胖≥30）进行分层。
在354例行TLH的患者中，90例有附件病变：69例为复杂肿块，16例存在BRCA1/2突变，5例为未分期的卵巢癌；48例BMI理想，26例超重，16例肥胖。各BMI组间的平均年龄（51岁）和产次（1.2个孩子）相似。34%为未生育。所有90例患者均接受了TLH、附件切除术及冲洗；14例行阑尾切除术，5例行淋巴结清扫术，3例行淋巴结采样，6例行大网膜切除术，8例行输尿管松解术，1例行Burch手术。各BMI组间的平均手术时长（156分钟）、失血量（152cc）及住院时间（1.9天）相似。每次淋巴结清扫的平均淋巴结收获量为14个，采样的平均收获量为2.6个。盆腔肿块的平均大小为8cm（范围3 - 19cm）。有7例卵巢癌：2例为ⅠA期，1例为ⅠB期，2例为ⅠC期，1例为ⅡC期，1例为ⅢB期；1例复发性乳腺癌，16例腺纤维瘤，15例子宫内膜异位症，10例皮样囊肿，41例浆液性/黏液性囊腺瘤。平均并发症发生率为6.6%（无显著性差异）：1例血清肿，1例血肿，1例梗阻性粘连，3例泌尿系统损伤。所有泌尿系统损伤均发生在患者中的前三分之一。
在肿瘤学实践中，无论BMI如何，TLH对有附件病变的女性似乎都是可行的。这些初步数据可为TLH与经腹子宫切除术（TAH）及腹腔镜辅助阴式子宫切除术（LAVH）的随机对照试验提供指导方针，并帮助外科医生避免我们早期出现的并发症。
