Morgan D J, Hunter D C, McCracken G, McClelland H R, Price J H, Dobbs S P
Stranmillis, Belfast, Northern Ireland, UK [corrected].
BJOG. 2007 May;114(5):537-42. doi: 10.1111/j.1471-0528.2007.01291.x. Epub 2007 Mar 13.
To compare a new surgical approach, laparoscopically assisted radical vaginal hysterectomy (LARVH) with open radical hysterectomy in women with cervical cancer. Can selected women benefit from the minimally invasive approach without compromising safety (recurrence rate) and morbidity (complications)?
Retrospective case control study.
A tertiary referral unit for gynaecological malignancies.
Thirty women undergoing LARVH were included and compared with 30 women undergoing open radical surgery. The control group was matched for age, body mass index and disease stage.
Retrospective collection of data from patient files and follow up.
Recurrence rate, complication rate, hospital stay, nodal counts, blood loss, operating time.
Recurrence rates were equal (6.7%). There was one death, in the LARVH group. Follow up was mean 31 months in the LARVH group and 30.9 months in the open group. Blood loss as measured by mean drop in haemoglobin was greater in the open group (2.03 versus 3.01 g/dl, P = 0.02). Transfusions were given in 40% of women in the open group and 16.7% in the LARVH group. Hospital stay was significantly less in the LARVH group (5.9 versus 7.8 nights, P = 0.003). Mean operating time was longer in the LARVH group (131 versus 187 minutes P = 0.0001). Mean nodal counts did not differ significantly (17.4 in open vs 14.8 in LARVH, P > 0.05). There were seven perioperative complications in the open group and four in the LARVH group. There have been two recurrences in each group (6.67%) at mean follow up of 31 (LARVH) and 30.9 (open) months.
The first 30 LARVH procedures performed in this unit are comparable in terms of safety (recurrence rate and complication rate) and economic factors (shorter hospital stay mitigating longer operating time). Further development of this technique is warranted.
比较一种新的手术方法，即腹腔镜辅助根治性阴道子宫切除术（LARVH）与开放性根治性子宫切除术在宫颈癌女性患者中的应用效果。特定的女性患者能否从这种微创方法中获益，同时又不影响安全性（复发率）和发病率（并发症）？
回顾性病例对照研究。
一家妇科恶性肿瘤三级转诊单位。
纳入30例行LARVH的女性患者，并与30例行开放性根治性手术的女性患者进行比较。对照组在年龄、体重指数和疾病分期方面进行了匹配。
从患者病历中回顾性收集数据并进行随访。
复发率、并发症发生率、住院时间、淋巴结计数、失血量、手术时间。
复发率相同（6.7%）。LARVH组有1例死亡。LARVH组的平均随访时间为31个月，开放组为30.9个月。以血红蛋白平均下降量衡量的失血量在开放组更大（2.03对3.01 g/dl，P = 0.02）。开放组40%的女性接受了输血，LARVH组为16.7%。LARVH组的住院时间明显更短（5.9对7.8晚，P = 0.003）。LARVH组的平均手术时间更长（131对187分钟，P = 0.0001）。平均淋巴结计数无显著差异（开放组为17.4，LARVH组为14.8，P > 0.05）。开放组有7例围手术期并发症，LARVH组有4例。在平均随访31个月（LARVH组）和30.9个月（开放组）时，每组均有2例复发（6.67%）。
该单位进行的前30例LARVH手术在安全性（复发率和并发症发生率）和经济因素（较短的住院时间弥补了较长的手术时间）方面具有可比性。这种技术值得进一步发展。
