Hatch K D, Hallum A V, Nour M
Gynecologic Oncology Division, University of Arizona, Tucson 85724, USA.
J Natl Cancer Inst Monogr. 1996(21):71-5.
Our goal was to evaluate laparoscopic pelvic lymph node dissection, para-aortic lymph node sampling, and laparoscopic radical vaginal hysterectomy (Schauta) in the treatment of early stage cervical cancer.
In a retrospective study of 37 patients treated in the period between October 1993 and February 1996, we evaluated operative time, blood loss, length of hospital stay, lymph node count, and morbidity. Radical abdominal hysterectomy was compared with laparoscopic pelvic lymph node dissection and para-aortic lymph node sampling. Improvement over time was analyzed.
Mean operative time was 225 minutes, blood loss was 525 mL, and the average hospital stay was 3 days. This information was compared with a radical abdominal hysterectomy and pelvic and para-aortic lymph node dissection, where the operative time was 210 minutes, blood loss was 1500 mL, and the hospital stay was 9.7 days. Blood transfusion was required in 11% of patients compared with a range of 35%-95% reported in the literature for radical abdominal hysterectomy. The mean pelvic lymph node count was 35; the mean para-aortic lymph node count was 11. Two patients had cystotomies repaired at surgery without lengthening hospital stay or subsequent complication. Two patients had ureteral vaginal fistulae treated by a ureteral stent, which was removed 6 weeks later without further operative procedures or urinary damage. When the data were correlated with the length of experience using the analysis of variance test and linear regression, operative time, blood loss, and hospital costs significantly improved over time. Patient charges averaged $14,868.00 and estimated hospital costs averaged $6449.00.
Laparoscopic pelvic lymph node dissection and para-aortic lymph node sampling can be performed with adequate lymph node counts and lower morbidity. Laparoscopic Schauta allows shorter hospital stay than radical abdominal hysterectomy, with significantly less blood loss and markedly fewer blood transfusions. Morbidity is higher early in the surgeon's experience but decreases over time.
我们的目标是评估腹腔镜盆腔淋巴结清扫术、腹主动脉旁淋巴结取样术以及腹腔镜根治性阴道子宫切除术（肖陶氏手术）在早期宫颈癌治疗中的应用。
在一项对1993年10月至1996年2月期间接受治疗的37例患者的回顾性研究中，我们评估了手术时间、失血量、住院时间、淋巴结计数以及发病率。将根治性腹式子宫切除术与腹腔镜盆腔淋巴结清扫术及腹主动脉旁淋巴结取样术进行了比较。分析了随时间的改善情况。
平均手术时间为225分钟，失血量为525毫升，平均住院时间为3天。将这些信息与根治性腹式子宫切除术及盆腔和腹主动脉旁淋巴结清扫术进行了比较，后者的手术时间为210分钟，失血量为1500毫升，住院时间为9.7天。11%的患者需要输血，而文献报道根治性腹式子宫切除术的输血率在35% - 95%之间。平均盆腔淋巴结计数为35个；平均腹主动脉旁淋巴结计数为11个。两名患者在手术中膀胱切开术得到修复，未延长住院时间或出现后续并发症。两名患者的输尿管阴道瘘通过输尿管支架进行治疗，6周后取出支架，未进行进一步手术或出现泌尿系统损伤。当使用方差分析测试和线性回归将数据与经验时长相关联时，手术时间、失血量和住院费用随时间显著改善。患者费用平均为14,868.00美元，估计住院费用平均为6449.00美元。
腹腔镜盆腔淋巴结清扫术和腹主动脉旁淋巴结取样术能够在获得足够淋巴结计数的情况下进行，且发病率较低。腹腔镜肖陶氏手术比根治性腹式子宫切除术的住院时间更短，失血量显著减少，输血次数明显减少。在外科医生经验积累的早期发病率较高，但随时间会降低。
