| Objective:Aim to collect and analysis the clinical date of cervical cancer, investigate the clinical value of laparoscopic surgery in treating early stage cervical carcinoma, and study the feasibility of treating the cervical cancer of early-stage with systemic laparoscopic nerve-sparing radical hysterectomy, and assess its protection of bladder as well as rectum function.Methods:A retrospective analysis and summary was carried out of the clinical and pathology data of134patients from Jeanery2009to March2012in the second hospital attached to Shanxi Medical University. A retrospective analysis was also carried out to compare the clinical parameters of laparoscopic and laparotomic surgery in treating early stage of cervical carcinoma, such as operative time, blood loss, complication and postoperative recovery. Further more, Among36cases whose patients underwent laparoscopy, comparisons were made between10cases that underwent SNSRH and26cases that had traditional radical hysterectomy. All cases’operative time, blood loss, complication, as well as bladder and rectum function was observed after the operation. Results:1. The age of patients is from29to68.The average age is49.98years old, the peak focus on46-55years old. Average age continue its downward trend from2009to2011, but the differences were not statistically obvious.2. Among134cases, there are9in stage Ⅰ a1(6.7%),2in stage Ⅰ a2(1.5%),50in stage Ⅰ b1(37.7%),5in stage Ⅰ b2(3.7%),35in stage Ⅱ a (26.1%),28in stage Ⅱ b (20.9%),3in stage Ⅲa (2.2%) and2in stage Ⅲb (1.5%). Squamous carcinoma accounts for99.3%(133cases), adenocarcinoma accounts for0.7%(1eases). As for pathological grading, G3accounts for19.4%(26cases), G2accounts for59.0%(79cases), G1accounts for15.7%(21cases), others account for6.0%(8cases).3. Among100cases that had pelvic lymph node dissection,5cases appear single site lymph node metastasis,4cases appear multiple sites lymph node metastasis. The average dissected lymph nodes are19.87. The total lymph node metastasis rate is1.11%. Parametrial lymph node metastasis occurs in2cases (9.09%). Obturator lymph node metastasis occurs in9cases (40.9%). Iliac lymph node metastasis occurs in10cases (45.45%). Inguinal lymph node metastasis occurs in1case (4.54%).4. The main symptom is irregular vaginal bleeding (30.6%), fallowed by contact bleeding, accounting for26.1%. The patients who complain both symptoms mentioned above account for5.2%. Simply abnormal leucorrhoea account for6.0%; abnormal leucorrhoea accompanied with irregular vaginal bleeding or contact bleeding account for23.9%. and no obvious symptom account for7.5%.5. There are100cervical cancer Patients underwent radical hysterectomy, among which,69patients keep no ovary,17had one reserved, and14had both after surgery.10patients out of36who accepted laparoscopic operation underwent SNSRH. Among134patients,44simply received chemotherapy,4simply received radiotherapy, and25had both. There are30cases underwent neoadjuvant chemotherapy (NACT).6. The average operating duration was224.72±40.90min in laparoscopy group and195.29±44.04min in laparotomy group, respectively(P<0.05). And the mean operative blood loss was312.50±326.75ml and581.25±326.21ml respectively(P<0.01). Average numbers of pelvic lymph nodes removed were21.61±9.09in laparoscopy group and18.71±7.11in laparotomy group. No significant difference was found between the two groups when numbers of lymph nodes were compared.7. The average time of recovery of bowel function were3.03±0.97d in laparoscopy group and3.45±0.81d in laparotomy group,(P<0.05). The mean time of the usage of antibiotics was10.42±2.80d, and13.68±5.53d respectively(P<0.05). No significant difference was found between the two groups when postoperative morbidity, bladder function and the length of hospital stays were compared.8. There were no significant difference in the average operation time, the estimated blood loss and the incidence of lymphocele during the operation between the two group (P>0.05).9. The average duration of indwelling catheter was shorter in SNSRH group (17.5±5.95d) than that in LRH group (22.58±7.20d). The postoperative residual urine volume of SNSRH group and LRH group were93.47±91.86ml and245.60±203.06ml. The first exhaust time of SNSRH group and LRH group were2.30±0.48d and3.32±0.91d, P＜0.01. There were notably significant differences in the postvoid residual urine volume and the first exhaust time between the two group (P＜0.05).Conclusion:1. Epidemiological data:There is a single peak on the age of patients, which focus on46-55years old. Squamous carcinoma contributes the largest proportion. The main symptoms contain irregular vaginal bleeding, contact bleeding and abnormal leucorrhoea. Obturator lymph node metastasis and iliac lymph node metastasis are more liable to occur. Surgery is still the main treatment of early-stage cervical carcinoma. The indication of surgery can be enlarged if chemotherapy and radiotherapy were undergone before as assistants. 2. Laparoscopy group has less blood lose, shorter operating duration and faster recovery after surgery. The numbers of pelvic lymph nodes removed were alike in both groups. In Short-term curative effect, Laparoscopic radical hysterectomy is considered as a minimally invasive, safe and feasible treatment, which has favourable clinical value.3. The Laparoscopic SNSRH operation does not increase the estimated blood loss during the operation and surgical complications that demonstrates its perfect security. Performing Laparoscopic SNSRH on patients could preserve the surgical radical extension. as well as reduce the incidence of postoperative bladder and rectum dysfunction, which could improve the quality of patients’life. All in all, Laparoscopic SNSRH embraces perfect applied prospective. |
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