Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Davis, Medical Center, CA, USA.
Int J Gynecol Cancer. 2009 Nov;19(8):1370-6. doi: 10.1111/IGC.0b013e3181a83db8.
To compare the demographics, cancer characteristics, and hospital outcomes of endometrial cancer patients undergoing a laparoscopically assisted vaginal hysterectomy (LAVH) versus a total abdominal hysterectomy (TAH).
Two California population databases (Office of Statewide Health Planning and Development and the California Cancer Registry) were linked using patient identifiers. Patients who underwent endometrial cancer surgery from 1997 to 2001 were identified. The combined database was queried for type of surgery, patient demographics, hospital outcomes, comorbidities, and cancer characteristics. Statistical analyses included the t test, chi2 test, and logistic regression.
In this study, 978 endometrial cancer patients (7.7%) had an LAVH and 11,765 (92.3%) had a TAH. The mean ages for the 2 groups were 63.3 and 64.8 years, respectively. Lymphadenectomy was performed more frequently in LAVH patients compared with TAH patients (45.6 vs 41.1%; P = 0.006). Patients undergoing LAVH were more likely to be younger and healthier and have stage I or grade 1 disease (P < 0.0001). Total abdominal hysterectomy patients were more likely to have significant medical comorbidities. Mean length of stay for LAVH was 2.40 versus 4.36 days for TAH (P < 0.001), but mean hospital charges were comparable. Perioperative complications such as vascular and bowel injuries, pulmonary embolism, wound problems, and transfusions were significantly more common in TAH patients.
Surgeons seem to carefully select endometrial cancer patients for laparoscopic surgery. Although surgical staging was performed in less than 50% of endometrial cancer patients, the rate was not worse in laparoscopic procedures. Short-term hospital complications were less common in the laparoscopy group.
比较行腹腔镜辅助阴式子宫切除术（LAVH）与全子宫切除术（TAH）的子宫内膜癌患者的人口统计学、癌症特征和医院结局。
使用患者标识符将加利福尼亚州两个人口数据库（州卫生计划和发展办公室和加利福尼亚癌症登记处）进行链接。从 1997 年至 2001 年，确定接受子宫内膜癌手术的患者。对合并数据库进行了手术类型、患者人口统计学、医院结局、合并症和癌症特征的查询。统计分析包括 t 检验、卡方检验和逻辑回归。
在这项研究中，978 例子宫内膜癌患者（7.7%）行 LAVH，11765 例（92.3%）行 TAH。两组的平均年龄分别为 63.3 岁和 64.8 岁。与 TAH 患者相比，LAVH 患者行淋巴结切除术的频率更高（45.6%比 41.1%；P=0.006）。行 LAVH 的患者更年轻、更健康，且处于 I 期或 1 级疾病（P<0.0001）。TAH 患者更可能患有严重的医疗合并症。LAVH 的平均住院时间为 2.40 天，TAH 为 4.36 天（P<0.001），但平均住院费用相当。围手术期并发症，如血管和肠损伤、肺栓塞、伤口问题和输血，在 TAH 患者中更为常见。
外科医生似乎仔细选择接受腹腔镜手术的子宫内膜癌患者。尽管不到 50%的子宫内膜癌患者进行了手术分期，但腹腔镜手术的比例并没有更差。腹腔镜组的短期医院并发症较少。
