Department of Obstetrics and Gynecology, Chung-Ang University School of Medicine/Chung-Ang University Hospital, 224-1, Heuksuk-Dong, Dongjak-Gu, Seoul 156-755, Republic of Korea.
Eur J Obstet Gynecol Reprod Biol. 2011 May;156(1):83-6. doi: 10.1016/j.ejogrb.2010.12.016. Epub 2011 Jan 26.
To determine whether laparoscopic radical hysterectomy (LRH) is a feasible alternative to radical abdominal hysterectomy (RAH) for early-stage cervical cancer.
A retrospective, matched case-control study of 24 consecutive cases with International Federation of Gynecology and Obstetrics stage I-II cervical cancer who underwent LRH by a single surgeon between January 1994 and December 2001. Cases were matched with controls (ratio 1:2) who underwent RAH by surgeon, age, stage and histology. Patient characteristics, clinical course, intra-operative complications and disease-free survival were compared between the two groups. Median counts were analyzed using the Mann-Whitney U-test. Differences between means were compared using Student's t-test. Dichotomous groupings were analyzed using Chi-squared test and Fisher's exact test as appropriate. Survival data were estimated using Kaplan-Meier estimates and compared with the log-rank test.
The mean estimated blood loss in the RAH group was significantly greater than that in the LRH group (836.0 ml and 414.3 ml, respectively; p<0.001). Five patients (20.8%) from the LRH group and 23 patients (47.9%) from the RAH group received blood transfusion (p<0.03). The mean length of hospital stay was significantly shorter in the LRH group compared with the RAH group (10.7 days and 18.8 days, respectively; p<0.01). No statistically significant difference existed between the two groups with respect to operative time, pelvic lymph node count, frequency of lymph node involvement, extent of parametrial or vaginal resection margins, adjuvant treatment and intra-operative complications. Median follow-up was 78 months for the LRH group and 75 months for the RAH group. There was no significant difference in the 5-year disease-free survival rate between the groups (90.5% and 93.3% for LRH and RAH, respectively; p=0.918).
LRH is a useful alternative to RAH for the management of early-stage cervical cancer. The benefits of LRH include reduced blood loss, fewer transfusions and shorter hospital stay, with comparable oncologic outcome.
探讨腹腔镜根治性子宫切除术（LRH）是否可作为早期宫颈癌根治性腹式子宫切除术（RAH）的替代方法。
回顾性、配对病例对照研究，对 1994 年 1 月至 2001 年 12 月间由同一位外科医生实施的 24 例国际妇产科联合会（FIGO）Ⅰ-Ⅱ期宫颈癌患者的病例进行分析，这些患者均行 LRH。通过外科医生、年龄、分期和组织学进行配对，选择同期行 RAH 的患者作为对照组，比例为 1:2。比较两组患者的一般特征、临床经过、术中并发症和无病生存率。使用 Mann-Whitney U 检验分析中位数，使用 Student's t 检验比较均值，使用卡方检验和 Fisher 确切概率法分析二分类变量。采用 Kaplan-Meier 估计法计算生存率，并采用对数秩检验比较。
RAH 组的平均估计失血量明显多于 LRH 组（分别为 836.0ml 和 414.3ml，p<0.001）。LRH 组有 5 例（20.8%）患者和 RAH 组有 23 例（47.9%）患者接受输血（p<0.03）。LRH 组的平均住院时间明显短于 RAH 组（分别为 10.7 天和 18.8 天，p<0.01）。两组在手术时间、盆腔淋巴结计数、淋巴结受累频率、宫旁或阴道切除范围、辅助治疗和术中并发症等方面无统计学差异。LRH 组中位随访时间为 78 个月，RAH 组为 75 个月。两组 5 年无病生存率无显著差异（LRH 组和 RAH 组分别为 90.5%和 93.3%，p=0.918）。
LRH 是早期宫颈癌治疗的一种有效替代方法，具有减少出血量、减少输血和缩短住院时间的优点，且肿瘤学结局相当。
