Hou Cai-Ying, Li Xiu-Li, Jiang Feng, Gong Rong Jie, Guo Xin Yu, Yao Yuan-Qing
Department of Gynecology and Obstetrics, PLA General Hospital, Beijing 100853.
Oncol Lett. 2011 Jul;2(4):747-752. doi: 10.3892/ol.2011.311. Epub 2011 May 13.
The aim of this study was to objectively evaluate the benefits of laparoscopically assisted vaginal radical hysterectomy and lymphadenectomy for early-stage cervical cancer. Clinical data were prospectively collected from patients with IA-IIB cervical cancer who underwent laparoscopically assisted vaginal radical hysterectomy (n1=33) and laparotomy (n2=30). Peripheral blood samples were obtained prior to surgery and at 1 and 2 h into the operation, as well as on days 1, 4 and 7 following surgery to measure serum interleukin-6, C-reaction protein and cortisol. Results showed that there was no conversion to laparotomy in the laparoscopy group. The average blood loss was 317.23±217.20 ml (laparoscopy group) and 872.58±693.16 ml (laparotomy group). No significant difference was found in the number of resected pelvic lymph nodes (19.74±7.43 in the laparoscopy group and 20.35±6.62 in the laparotomy group). At days 1 and 7 after surgery, the serum IL-6 level was significantly different in the laparoscopy and laparotomy groups (day 1: laparoscopy group 17.14±16.53 pg/ml and laparotomy group 34.32±20.97 pg/ml, p=0.001; day 7: laparoscopy group 6.7±7.21 pg/ml and laparotomy group 17.54±16.47 pg/ml, p=0.001). The serum CRP level was significantly different at days 1 and 7 after the operation (day 1: laparoscopy group 7024.72±949.12 ng/ml and laparotomy group 7586.61±869.42 ng/ml, p=0.018; day 7: laparoscopy group 4357.71±2108.85 ng/ml and laparotomy group 6967.96±995.02 ng/ml, p<0.001). A significant difference was noted in the serum cortisol level at day 4 after the operation (122.29±65.17 ng/ml in the laparoscopy group and 186.76±68.61 ng/ml in the laparotomy group, p<0.001). In conclusion, the differences in clinical data and the various parameters pertinent to surgical stress evaluated in this study suggest that laparoscopic surgery for cervical cancer causes less postoperative stress than conventional open surgery.
本研究的目的是客观评估腹腔镜辅助阴式根治性子宫切除术及淋巴结清扫术治疗早期宫颈癌的益处。前瞻性收集接受腹腔镜辅助阴式根治性子宫切除术（n1 = 33）和开腹手术（n2 = 30）的IA-IIB期宫颈癌患者的临床资料。在手术前、手术开始后1小时和2小时以及手术后第1、4和7天采集外周血样本，以检测血清白细胞介素-6、C反应蛋白和皮质醇。结果显示，腹腔镜组无中转开腹病例。平均失血量腹腔镜组为317.23±217.20 ml，开腹组为872.58±693.16 ml。切除的盆腔淋巴结数量差异无统计学意义（腹腔镜组为19.74±7.43，开腹组为20.35±6.62）。在术后第1天和第7天，腹腔镜组和开腹组的血清IL-6水平差异有统计学意义（第1天：腹腔镜组17.14±16.53 pg/ml，开腹组34.32±20.97 pg/ml，p = 0.001；第7天：腹腔镜组6.7±7.21 pg/ml，开腹组17.54±16.47 pg/ml，p = 0.001）。术后第1天和第7天血清CRP水平差异有统计学意义（第1天：腹腔镜组7024.72±949.12 ng/ml，开腹组7586.61±869.42 ng/ml，p = 0.018；第7天：腹腔镜组4357.71±2108.85 ng/ml，开腹组6967.96±995.02 ng/ml，p<0.001）。术后第4天血清皮质醇水平差异有统计学意义（腹腔镜组为122.29±65.17 ng/ml，开腹组为186.76±68.61 ng/ml，p<0.001）。总之，本研究评估的临床资料及与手术应激相关的各项参数的差异表明，宫颈癌腹腔镜手术比传统开放手术引起的术后应激更小。
