West Kent Cancer Centre, Maidstone Hospital, Kent, ME16 1QQ, UK.
Int J Gynecol Cancer. 2010 May;20(4):570-5. doi: 10.1111/IGC.0b013e3181d8b105.
To determine the feasibility and safety of laparoscopically assisted vaginal hysterectomy in the treatment of presumed stage I endometrial cancer.
This was a prospective cohort study without randomization of 182 consecutive patients who underwent surgery for early endometrial cancer or atypical hyperplasia at the West Kent Gynaecological Oncology Centre, UK. Seventy-four had laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (BSO), and 108 had a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy was performed in 153 patients, and lymph node sampling was performed in 2 patients. Twenty-seven patients with serous papillary endometrial cancer in addition had an omentectomy. The groups were compared for epidemiological and clinical characteristics, surgical outcomes, hospital stay, lymph node harvest, and intraoperative and postoperative complications.
The patients in the laparoscopy group had less blood loss, similar number of lymph nodes removed, less need for analgesia, and shorter hospital stay but longer operative time than those treated by laparotomy. In our study, we had 4 conversions (5.4%) from laparoscopy to laparotomy. Twenty-eight (41%) patients who had laparoscopic surgery were obese (body mass index [BMI] >30 kg/m2). Postoperative complications were more common in the laparotomy group (34%) than in the laparoscopy group (6%). No major complications occurred in the laparoscopy group. Wound infection was the most common complication in laparotomy patients, and this invariably happened to obese patients (BMI >30 kg/m2). There were 6 readmissions, all from the laparotomy group.
Laparoscopic surgery is a safe and reliable alternative to open surgery in the management of early endometrial cancer patients, with significantly reduced hospital stay and complications, especially in those patients with an elevated BMI.
确定腹腔镜辅助阴道子宫切除术治疗疑似 I 期子宫内膜癌的可行性和安全性。
这是一项英国西肯特妇科肿瘤中心对 182 例连续早期子宫内膜癌或非典型增生患者进行的前瞻性队列研究，无随机分组。74 例行腹腔镜辅助阴道子宫切除术和双侧输卵管卵巢切除术（BSO），108 例行全腹子宫切除术和双侧输卵管卵巢切除术。153 例行淋巴结切除术，2 例行淋巴结取样术。27 例浆液性乳头状子宫内膜癌患者加行网膜切除术。比较两组患者的流行病学和临床特征、手术结果、住院时间、淋巴结采集以及术中术后并发症。
腹腔镜组患者出血量较少，切除的淋巴结数量相似，对镇痛的需求较少，住院时间较短，但手术时间较长。在我们的研究中，有 4 例（5.4%）从腹腔镜转为开腹。28 例（41%）腹腔镜手术患者肥胖（体重指数[BMI] >30 kg/m2）。腹腔镜组术后并发症（34%）较开腹组（41%）更为常见。腹腔镜组无重大并发症发生。开腹组患者中，切口感染最为常见，且均发生于肥胖患者（BMI >30 kg/m2）。有 6 例再次入院，均来自开腹组。
腹腔镜手术是治疗早期子宫内膜癌患者的一种安全可靠的替代方法，可显著缩短住院时间和减少并发症，尤其适用于 BMI 较高的患者。
