腹腔镜与经腹宫颈癌手术并发症的对比分析

Comparative analysis of the complications of laparoscopic and abdominal cervical cancer surgery

摘要:

目的 比较腹腔镜与经腹宫颈癌手术并发症，探讨腹腔镜手术的安全性，对两者并发症Clavien-Dindo分级及相关危险因素进行分析。方法 回顾性分析2011年3月-2014年10月该院204例（选择215例，有11例失访）宫颈癌患者行广泛性子宫切除手术的临床资料。分为腹腔镜下广泛性子宫切除术（LRH）组和经腹广泛性子宫切除术（ARH）组。分析比较两者间术中、术后并发症及其危险程度和随访资料等，评估腹腔镜宫颈癌手术的安全性及分析并发症相关的独立危险因素。结果 204例研究对象中并发症归纳为4个等级。两组并发症发生率及危险程度比较差异均无统计学意义（P >0.05）。两组间复发及死亡率比较差异无统计学意义（P > 0.05）。根据Logistic回归分析，ARH组严重程度为Ⅱ级以上术中并发症与手术时间有关，ARH组严重程度Ⅱ级以上并发症与年龄大于50岁的女性有关，ARH组术后严重程度为Ⅱ级以上并发症与超重（体质指数>25）有关。结论 通过对两组手术并发症及其危险程度的分析，得出两组安全性无差异，手术对有高危因素的患者需要全面进行评估，严格把握其适应证及禁忌证。

Abstract:

Objective Compare the complications between laparoscopic and abdominal cervical cancer surgery, and investigate the safety of laparoscopic cervical cancer surgery and complications classified by Clavien-Dindo classification, then analyze the risk factors. Method Clinical data of 215 cases of cervical cancer received surgery from March 2011 to October 2014 was collected, which include intraoperative, postoperative and postoperative follow-up data. All the cases were divided into two groups: LRH group (n = 116) and ARH group (n = 88), then analyze and compare the difference of intraoperative, postoperative complications and postoperative follow-up data between the two groups, assess the safety of the two groups, and statistically concluded related independent risk factors. Results The complications of 204 patients were classified into 4 grades. The criticality and morbidity of intraoperative and postoperative complications have no significant difference between the two groups (P > 0.05). Logistic regression analysis show that over criticality grade Ⅱ of LRH intraoperative complication related to operating time, over criticality grade Ⅱ of ARH intraoperative complication related to aged over 50 yr, over criticality grade Ⅱ of ARH intraoperative complication related to BMI > 25. Conclusions Through the analysis of laparoscopic operation and the criticality of complications, the safety of the two groups were no difference. The patients with high risk factors should be evaluated comprehensively. And strictly grasp the contraindication and indication.