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目的探讨单孔腹腔镜广泛子宫切除盆腔淋巴结清扫治疗早期宫颈癌的可行性、安全性和短期临床结局。方法 2016年10月至2017年3月前瞻性纳入第三军医大学西南医院妇产科诊断为宫颈癌的患者,行单孔腹腔镜广泛子宫切除+盆腔淋巴结清扫术。统计患者人口学特征、临床肿瘤学结局和围手术期效果。结果 27例患者尝试手术,26例成功完成(96%),1例因术中探查合并Ⅳ期子宫内膜异位症而中转为多孔腹腔镜手术。患者中位年龄46岁,体质量指数为22.1 kg/m~2,中位手术时间237 min,术中失血量平均186 mL。2例术中血管损伤,1例膀胱损伤,均在术中单孔腹腔镜下完成修补。平均盆腔淋巴结清扫数目21枚,手术切缘病理学检查均为阴性。1例患者因2枚盆腔淋巴结转移,术后进行化疗+放疗;7例合并中危因素患者,术后进行放疗。结论具有丰富的妇科肿瘤腹腔镜手术经验的医生熟练掌握单孔腹腔镜手术技术的情况下,采用单孔腹腔镜手术是进行广泛子宫切除盆腔淋巴结清扫手术是可行的。
Objective To investigate the feasibility, safety and short-term clinical outcome of single-hole laparoscopic radical hysterectomy for pelvic lymph node dissection for early cervical cancer. Methods From October 2016 to March 2017, we prospectively enrolled patients diagnosed as cervical cancer in the department of gynecology and obstetrics of the Southwest Hospital of the Third Military Medical University with single-hole laparoscopic radical hysterectomy and pelvic lymphadenectomy. Demographic characteristics of patients, clinical oncology outcomes and perioperative effects. Results Twenty - seven patients underwent surgery, 26 achieved complete success (96%), and 1 was converted to porous laparoscopic surgery due to intraoperative exploration combined with stage Ⅳ endometriosis. The median age was 46 years. The body mass index was 22.1 kg / m ~ 2. The median operative time was 237 min. The average blood loss during operation was 186 mL. 2 cases of intraoperative vascular injury, 1 case of bladder injury, were completed intraoperative single hole laparoscopic repair. The average number of pelvic lymph node dissection 21, surgical margins pathological examination were negative. One patient had two pelvic lymph node metastases and received chemotherapy and radiotherapy after operation. Seven patients with risk factors were treated with radiotherapy. CONCLUSIONS: It is feasible to use single hole laparoscopic surgery to perform extensive hysterectomy pelvic lymph node dissection under the condition that a doctor with rich experience in laparoscopic surgery of gynecologic oncology is proficient in single hole laparoscopic surgery.