Malinowski Andrzej, Majchrzak-Baczmańska Dominika, Pogoda Krzysztof, Maciołek-Blewniewska Grazyna, Antosiak Beata
Department of Surgical and Endoscopic Gynecology Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland.
Ginekol Pol. 2013 Mar;84(3):197-205. doi: 10.17772/gp/1563.
The study was conducted to evaluate the efficacy feasibility and safety of total laparoscopic hysterectomy (TLH) with lymphadenectomy in the treatment of endometrial cancer
The retrospective study included 31 patients with endometrial cancer who underwent TLH with lymphadenectomy and 42 patients with endometrial cancer who were operated by laparotomy. In both groups the following parameters were analyzed: age, BMI, accompanying diseases, previous surgeries, parity duration of the surgery blood loss (complete blood count before and after the operation was compared), necessity of blood transfusion, length of hospital stay uterine volume, grade, stage of endometrial cancer (FIGO), and intra/ postoperative complications.
Mean age of patients was lower in the laparoscopic group than in women operated by laparotomy: 54 and 64, respectively (p = 0.0001). There were no significant differences between both groups in BMI, uterine volume, grade, staging (FIGO), and parity The percentage of patients with accompanying chronic diseases in the TLH group was lower than in the laparotomy group: 48.39% and 83.34%, respectively (p = 0,032). There were no significant differences between both group in the history of previous laparotomies (p = 0.704). Mean duration of surgery was shorter in the case of laparotomy than in case of laparoscopy: 130.6 and 151.77, respectively (p = 0.003). Laparotomy was associated with greater blood loss during surgery Statistically significantly higher decrease in the Hb concentration and Hct values was noted in the group operated by laparotomy when compared to laparoscopy (mean values.: Hb-1.1 7 g/dl, Hct-3.49% for the TLH technique and Hb-7.8 g/dl Hct-5.47% for laparotomy; p = 0.011-Hb; p = 0.003-Hct). Mean hospital stay after laparoscopy was shorter than after laparotomy--4 and 9 days, respectively (p = 0,0001). The influence of the operational technique on the number of pelvic lymph nodes taken for histopathological examination was evaluated. No statistically significant correlation between the number of lymph nodes taken for histopathological examination during the surgery and the operational technique was noted (p = 0.083). Mean number of nodes taken for examination was 15 during the TLH surgery and 19 during laparotomy Postoperative complications were observed in 2 patients from the TLH and in 12 patients from the laparotomy groups (p = 0.038). The most statistically significantly frequent complication in the laparotomy group was postoperative wound infection: 8 (19.05%) patients.
Total laparoscopic hysterectomy with lymphadenectomy in endometrial cancer therapy is a safe and feasible procedure. It is characterized by significantly smaller percentage of complications and shorter hospital stay This technique offers an alternative for laparotomy when it is performed by a highly experienced surgeon.
本研究旨在评估全腹腔镜子宫切除术（TLH）联合淋巴结清扫术治疗子宫内膜癌的疗效、可行性及安全性。
这项回顾性研究纳入了31例行TLH联合淋巴结清扫术的子宫内膜癌患者以及42例行开腹手术的子宫内膜癌患者。对两组患者的以下参数进行了分析：年龄、体重指数（BMI）、伴随疾病、既往手术史、产次、手术时长、失血量（比较手术前后的血常规）、输血必要性、住院时间、子宫体积、子宫内膜癌的分级、分期（国际妇产科联盟（FIGO）分期）以及术中/术后并发症。
腹腔镜组患者的平均年龄低于开腹手术组患者，分别为54岁和64岁（p = 0.0001）。两组在BMI、子宫体积、分级、分期（FIGO）和产次方面无显著差异。TLH组伴有慢性病的患者百分比低于开腹手术组，分别为48.39%和83.34%（p = 0.032）。两组在既往开腹手术史方面无显著差异（p = 0.704）。开腹手术的平均手术时长比腹腔镜手术短，分别为130.6分钟和151.77分钟（p = 0.003）。开腹手术术中失血量更大。与腹腔镜手术相比，开腹手术组患者血红蛋白（Hb）浓度和红细胞压积（Hct）值的下降在统计学上显著更高（平均值：TLH技术组Hb - 1.17 g/dl，Hct - 3.49%；开腹手术组Hb - 7.8 g/dl，Hct - 5.47%；p = 0.011 - Hb；p = 0.003 - Hct）。腹腔镜手术后的平均住院时间比开腹手术短，分别为4天和9天（p = 0.0001）。评估了手术技术对用于组织病理学检查的盆腔淋巴结数量的影响。未发现手术中用于组织病理学检查的淋巴结数量与手术技术之间存在统计学上的显著相关性（p = 0.083）。TLH手术中平均送检淋巴结数量为15个，开腹手术中为19个。TLH组有2例患者出现术后并发症，开腹手术组有12例患者出现术后并发症（p = 0.038）。开腹手术组最常见的具有统计学显著意义的并发症是术后伤口感染：8例（19.05%）患者。
全腹腔镜子宫切除术联合淋巴结清扫术治疗子宫内膜癌是一种安全可行的手术。其特点是并发症发生率显著更低，住院时间更短。当由经验丰富的外科医生进行时，该技术为开腹手术提供了一种替代方案。
